{
"Npi": {
"NPI": "1598969800",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MAGNESS",
"FirstName": "TANYA",
"MiddleName": "L",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LPC, LADC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COPPENBARGER",
"OtherFirstName": "TANYA",
"OtherMiddleName": "L",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LPC, LADC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "300 E WOLF ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MADILL",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73446",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-730-0168",
"MailingAddressFaxNumber": "580-872-4661",
"FirstLinePracticeLocationAddress": "300 E WOLF ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MADILL",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73446",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-730-0168",
"PracticeLocationAddressFaxNumber": "580-872-4661",
"EnumerationDate": "06/12/2007",
"LastUpdateDate": "09/25/2019",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "3695",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "845",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}