{
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 328",
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"MailingAddressCityName": "LAMAR",
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"MailingAddressPostalCode": "81052-0328",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-336-3244",
"MailingAddressFaxNumber": "719-336-3898",
"FirstLinePracticeLocationAddress": "1104 S 4TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAMAR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-336-3244",
"PracticeLocationAddressFaxNumber": "719-336-3898",
"EnumerationDate": "01/28/2020",
"LastUpdateDate": "03/02/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FIENE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "719-336-3244",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}