{
"Npi": {
"NPI": "1497189179",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOSTA",
"FirstName": "JOANNE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPCC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2521 COUNTY ROAD 41",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREMONT",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43420-8980",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-355-9169",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "428 CROGHAN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREMONT",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43420-2448",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-355-9169",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/29/2013",
"LastUpdateDate": "06/20/2019",
"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": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "LCDC.131173",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "E.1800690",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}