{
"Npi": {
"NPI": "1568203677",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRINSON",
"FirstName": "LORISSIA",
"MiddleName": "NICOLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WILLIS",
"OtherFirstName": "LORISSIA",
"OtherMiddleName": "NICOLE",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "CSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 1080",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURKESVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42717-1080",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "270-864-1472",
"MailingAddressFaxNumber": "270-864-1693",
"FirstLinePracticeLocationAddress": "200 UNIVERSITY DRIVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ELIZABETHTOWN",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "42701-3117",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "844-435-0900",
"PracticeLocationAddressFaxNumber": "270-858-4029",
"EnumerationDate": "06/03/2024",
"LastUpdateDate": "07/24/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "258508",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}