{
"Npi": {
"NPI": "1649403544",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADHD CLINICS OF ARIZONA",
"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": "1016 W UNIVERSITY AVE",
"SecondLineMailingAddress": "202",
"MailingAddressCityName": "FLAGSTAFF",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86001-2994",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "928-773-7774",
"MailingAddressFaxNumber": "928-774-1148",
"FirstLinePracticeLocationAddress": "1016 W UNIVERSITY AVE",
"SecondLinePracticeLocationAddress": "202",
"PracticeLocationAddressCityName": "FLAGSTAFF",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "86001-2994",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-773-7774",
"PracticeLocationAddressFaxNumber": "928-774-1148",
"EnumerationDate": "08/26/2009",
"LastUpdateDate": "08/26/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PACKARD",
"AuthorizedOfficialFirstName": "BRUCE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ED.D., PC",
"AuthorizedOfficialTelephoneNumber": "928-773-7774",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": "3125",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}