{
"Npi": {
"NPI": "1609484062",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MENZ",
"FirstName": "CRISTON",
"MiddleName": "A",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MENZ",
"OtherFirstName": "CRIS",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LCSW",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1100 HOPKINS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKY FORD",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81067-2421",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-696-0910",
"MailingAddressFaxNumber": "719-316-2753",
"FirstLinePracticeLocationAddress": "408 N MAIN ST STE F",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROCKY FORD",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81067-1256",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-423-8834",
"PracticeLocationAddressFaxNumber": "719-316-2753",
"EnumerationDate": "07/21/2020",
"LastUpdateDate": "08/08/2022",
"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": "0009923059",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "CSW.09928454",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}