{
"Npi": {
"NPI": "1477339331",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DOUCETTE",
"FirstName": "JENAH",
"MiddleName": "ELIZABETH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "AMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DOUCETTE",
"OtherFirstName": "JAY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "AMFT",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "776 S STATE ST STE 103",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "UKIAH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95482-5833",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-463-4915",
"MailingAddressFaxNumber": "707-463-4917",
"FirstLinePracticeLocationAddress": "631 WOODSIDE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REDWOOD CITY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94061-3847",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-367-9030",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/06/2023",
"LastUpdateDate": "12/19/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "X",
"Gender": null,
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225400000X",
"TaxonomyName": "Rehabilitation Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "151549",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}