{
"Npi": {
"NPI": "1649281676",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PATHWAYS PSYCHOLOGY ON GRAND, PLLC",
"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": "1053 GRAND AVE",
"SecondLineMailingAddress": "SUITE 116",
"MailingAddressCityName": "SAINT PAUL",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55105-3022",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-287-0931",
"MailingAddressFaxNumber": "651-287-0967",
"FirstLinePracticeLocationAddress": "1053 GRAND AVE",
"SecondLinePracticeLocationAddress": "SUITE 116",
"PracticeLocationAddressCityName": "SAINT PAUL",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55105-3022",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-287-0931",
"PracticeLocationAddressFaxNumber": "651-287-0967",
"EnumerationDate": "08/11/2006",
"LastUpdateDate": "11/21/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEBLOND",
"AuthorizedOfficialFirstName": "JILL",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "HIPAA OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSYD, LP",
"AuthorizedOfficialTelephoneNumber": "651-287-0931",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}