{
"Npi": {
"NPI": "1558698282",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTEGRATIVE THERAPY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "209 VUELTA ROBLE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA FE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87501-1625",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-795-8190",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "128 GRANT AVE",
"SecondLinePracticeLocationAddress": "STE 218",
"PracticeLocationAddressCityName": "SANTA FE",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87501-2031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-795-8190",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/18/2009",
"LastUpdateDate": "12/07/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURNS",
"AuthorizedOfficialFirstName": "CAROLYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROPRIETOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "505-795-8190",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "0103251",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}