{
"Npi": {
"NPI": "1578457099",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "UKAEBEONYA",
"FirstName": "PROMISE",
"MiddleName": "C",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "UKAEBEONYA",
"OtherFirstName": "PROMISE",
"OtherMiddleName": "C",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "350 FAIRWAY DR STE FAIRWAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DEERFIELD BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33441-1834",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-418-2978",
"MailingAddressFaxNumber": "866-500-2186",
"FirstLinePracticeLocationAddress": "13500 MIDWAY RD STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FARMERS BRANCH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75244-5136",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-418-2978",
"PracticeLocationAddressFaxNumber": "866-500-2186",
"EnumerationDate": "06/09/2025",
"LastUpdateDate": "06/09/2025",
"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": "106S00000X",
"TaxonomyName": "Behavior Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}