{
"Npi": {
"NPI": "1710013073",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMMUNITY REACH CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "13293 NIWOT TRL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOMFIELD",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80020-5580",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-543-3894",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8989 HURON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THORNTON",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80260-6858",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-853-3697",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/23/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEISS",
"AuthorizedOfficialFirstName": "TRACELL",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "PROGAM MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "303-853-3697",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "LMFT 502",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}