{
"Npi": {
"NPI": "1659452159",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KING",
"FirstName": "ELISABETH",
"MiddleName": "D",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PSYD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "525 W MAIN ST STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VISALIA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93291-6116",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-697-3264",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "520 E TULARE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VISALIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93292-3629",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-623-0943",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/18/2006",
"LastUpdateDate": "10/24/2019",
"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": "103TF0200X",
"TaxonomyName": "Forensic Psychologist",
"LicenseNumber": "PSY20259",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}