{
"Npi": {
"NPI": "1568131076",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CONNER",
"FirstName": "GARRICK",
"MiddleName": "DEWAYNE",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "MA, LPC, LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8001 N HILLS BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH LITTLE ROCK",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72116-4904",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-551-4144",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "209 ROYA LANE, STE. 4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRYANT",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72022-7211",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-551-4144",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/08/2021",
"LastUpdateDate": "09/08/2021",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "P1308092",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "M1308044",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}