{
"Npi": {
"NPI": "1588737084",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COUNTY MENTAL HEALTH CLINIC",
"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": "422 CLUBHOUSE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA MARIA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93455-3633",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-934-2170",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "500 W FOSTER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA MARIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93455-3620",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-934-2170",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/15/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEPULVEDA",
"AuthorizedOfficialFirstName": "DALILA",
"AuthorizedOfficialMiddleName": "FIGUEROA",
"AuthorizedOfficialTitle": "MENTAL HEALTH PROCTITIONER -INTERN",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW",
"AuthorizedOfficialTelephoneNumber": "806-934-6367",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "ASW 12749",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}