{
"Npi": {
"NPI": "1609718402",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CONGRUENCE MENTAL HEALTH LLC",
"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": "200 N HIGHBROOK WAY STE 106",
"SecondLineMailingAddress": "PMB 510",
"MailingAddressCityName": "STAR",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83669-1028",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-418-9335",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4477 W EMERALD ST STE B150",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83706-2013",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-418-9335",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/08/2026",
"LastUpdateDate": "04/08/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURACCHIO",
"AuthorizedOfficialFirstName": "KATHERINE",
"AuthorizedOfficialMiddleName": "GAIL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APRN, PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "208-418-9335",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}