{
"Npi": {
"NPI": "1578008520",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEMPLE VALLEY MINDFUL WELLNESS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "47-610 HUI ULILI ST APT A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KANEOHE",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96744-4642",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-780-7603",
"MailingAddressFaxNumber": "888-974-1502",
"FirstLinePracticeLocationAddress": "1005 KEOLU DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KAILUA",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96734-3873",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-780-7603",
"PracticeLocationAddressFaxNumber": "888-974-1502",
"EnumerationDate": "12/30/2016",
"LastUpdateDate": "12/30/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHIPPLE",
"AuthorizedOfficialFirstName": "RACHEL",
"AuthorizedOfficialMiddleName": "ESTHER",
"AuthorizedOfficialTitle": "LCSW/THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "808-780-7603",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "329 LMFT",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "LCSW 4028",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
]
}
}
}