{
"Npi": {
"NPI": "1649798497",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BERRY-TIPPETT",
"FirstName": "KELSEY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PSYD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BERRY",
"OtherFirstName": "KELSEY",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PSYD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "9301 MADISON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CROWN POINT",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46307-7745",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-569-8387",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9301 MADISON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CROWN POINT",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46307-7745",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-569-8387",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/31/2017",
"LastUpdateDate": "02/17/2022",
"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": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "071.010620",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}