{
"Npi": {
"NPI": "1508395518",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "CHRYSALIS ENTERPRISES",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "11930 MENAUL BLVD NE",
"SecondLineMailingAddress": "SUITE #225C",
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87048",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-323-4447",
"MailingAddressFaxNumber": "505-323-5075",
"FirstLinePracticeLocationAddress": "11930 MENAUL BLVD NE STE 225C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALBUQUERQUE",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87112-2465",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-323-4447",
"PracticeLocationAddressFaxNumber": "505-323-5075",
"EnumerationDate": "06/05/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATSON",
"AuthorizedOfficialFirstName": "JULIE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "MEMBER",
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"AuthorizedOfficialCredential": "LPCC",
"AuthorizedOfficialTelephoneNumber": "505-323-4447",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "005683",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}