{
"Npi": {
"NPI": "1508053273",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CLINICAL PSYCHOPHARMACOLOGY CONSULTANTS, PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3601 PARK CENTER BLVD",
"SecondLineMailingAddress": "SUITE 207",
"MailingAddressCityName": "ST LOUIS PARK",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55416-2531",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-926-3364",
"MailingAddressFaxNumber": "952-926-3369",
"FirstLinePracticeLocationAddress": "3601 PARK CENTER BLVD",
"SecondLinePracticeLocationAddress": "SUITE 207",
"PracticeLocationAddressCityName": "ST LOUIS PARK",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55416-2531",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-926-3364",
"PracticeLocationAddressFaxNumber": "952-926-3369",
"EnumerationDate": "09/26/2007",
"LastUpdateDate": "09/26/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABUZZAHAB",
"AuthorizedOfficialFirstName": "FARUK",
"AuthorizedOfficialMiddleName": "SAID",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": "MD, PHD",
"AuthorizedOfficialTelephoneNumber": "952-926-3364",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "17068",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}