{
"Npi": {
"NPI": "1700118999",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MONARCH MENTAL HEALTH, LLC",
"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": "2115 E. SHERMAN AVE #104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COEUR D 'ALENE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83814",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-676-1075",
"MailingAddressFaxNumber": "208-676-1245",
"FirstLinePracticeLocationAddress": "2115 E. SHERMAN AVE #104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COEUR D 'ALENE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83814",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-676-1075",
"PracticeLocationAddressFaxNumber": "208-676-1245",
"EnumerationDate": "02/12/2010",
"LastUpdateDate": "05/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEONARD",
"AuthorizedOfficialFirstName": "LINDA",
"AuthorizedOfficialMiddleName": "MADREE",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "208-676-1075",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": "LCSW-29101",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "LCSW-29101",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": "LCSW-29101",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "LCSW-29101",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}