{
"Npi": {
"NPI": "1598360638",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEALTH AND WELLNESS PSYCHIATRY",
"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": "70 S VAL VISTA DR STE A3-659",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GILBERT",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85296-1374",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-269-2971",
"MailingAddressFaxNumber": "480-452-0691",
"FirstLinePracticeLocationAddress": "4001 E BASELINE RD STE 204",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GILBERT",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85234-2743",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-565-6440",
"PracticeLocationAddressFaxNumber": "480-452-0691",
"EnumerationDate": "12/04/2020",
"LastUpdateDate": "12/04/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DECKER",
"AuthorizedOfficialFirstName": "CONNIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "480-269-2971",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}