{
"Npi": {
"NPI": "1629217484",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BLUE SPRUCE ASSOCIATES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5151 S. SHERWOOD ST.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT COLLINS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80521-2842",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-221-0581",
"MailingAddressFaxNumber": "970-482-8541",
"FirstLinePracticeLocationAddress": "515 S. SHERWOOD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT COLLINS",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80521-2842",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-221-0581",
"PracticeLocationAddressFaxNumber": "970-482-8541",
"EnumerationDate": "02/18/2009",
"LastUpdateDate": "02/18/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAYNOR",
"AuthorizedOfficialFirstName": "PAMELA",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "DIRECTOR, CLINICAL PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "970-221-0581",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "292",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}