{
"Npi": {
"NPI": "1497261101",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JUDAH",
"FirstName": "MATTHEW",
"MiddleName": "R",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "JUDAH",
"OtherFirstName": "MATT",
"OtherMiddleName": "R",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PHD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "216 MEMORIAL HALL",
"SecondLineMailingAddress": "DEPARTMENT OF PSYCHOLOGICAL SCIENCE",
"MailingAddressCityName": "FAYETTEVILLE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72701",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-284-6835",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19 E MOUNTAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAYETTEVILLE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72701-6067",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-274-0881",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/18/2017",
"LastUpdateDate": "06/01/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "202112",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}