{
"Npi": {
"NPI": "1497104103",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANN WILSON, PSY.D. PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 173",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JEROME",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86331-0173",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "832-919-5732",
"MailingAddressFaxNumber": "832-583-0012",
"FirstLinePracticeLocationAddress": "2901 WILCREST DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOUSTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77042-3399",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "713-300-0713",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/03/2016",
"LastUpdateDate": "01/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILSON",
"AuthorizedOfficialFirstName": "ANN",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSY.D.",
"AuthorizedOfficialTelephoneNumber": "832-919-5732",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "36477",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}