{
"Npi": {
"NPI": "1659753937",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRANDON SEGURA",
"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": "11762 S 1000 E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANDY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84094-5630",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-696-2525",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "190 S MAIN ST",
"SecondLinePracticeLocationAddress": "STE 400",
"PracticeLocationAddressCityName": "CENTERVILLE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84014-2814",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-696-2525",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/23/2015",
"LastUpdateDate": "06/23/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEGURA",
"AuthorizedOfficialFirstName": "BRANDON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D",
"AuthorizedOfficialTelephoneNumber": "801-696-2525",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "5423955-2501",
"LicenseNumberStateCode": "UT",
"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."
}
}
}
}