{
"Npi": {
"NPI": "1609010982",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CARPENTER",
"FirstName": "TIFFANY",
"MiddleName": "KAYE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "L.C.S.W.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CAROTHERS",
"OtherFirstName": "TIFFANY",
"OtherMiddleName": "KAYE",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "L.M.S.W.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4200 RIDGECREST CIR STE A-6",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AMARILLO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79109-5416",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "806-282-5106",
"MailingAddressFaxNumber": "888-393-2231",
"FirstLinePracticeLocationAddress": "6010 W AMARILLO BLVD",
"SecondLinePracticeLocationAddress": "BLDG 45",
"PracticeLocationAddressCityName": "AMARILLO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79106-1990",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "806-355-9703",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/30/2009",
"LastUpdateDate": "06/29/2020",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "50518-170774",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}