{
"Npi": {
"NPI": "1487901609",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BASOV",
"FirstName": "ANNA",
"MiddleName": "R",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSYD, LCPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "601 SKOKIE BOULEVARD",
"SecondLineMailingAddress": "SUITE #LL-5D",
"MailingAddressCityName": "NORTHBROOK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60060-2813",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-607-1589",
"MailingAddressFaxNumber": "847-881-0839",
"FirstLinePracticeLocationAddress": "601 SKOKIE BLVD",
"SecondLinePracticeLocationAddress": "SUITE #LL-5D",
"PracticeLocationAddressCityName": "NORTHBROOK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60062-2851",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-607-1589",
"PracticeLocationAddressFaxNumber": "847-881-0839",
"EnumerationDate": "08/07/2012",
"LastUpdateDate": "10/28/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "180.009063",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "178.007955",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "071009153",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}