{
"Npi": {
"NPI": "1730451055",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
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"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"MiddleName": "ANTHONY",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "BA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MIRABAL",
"OtherFirstName": "JOE",
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"OtherCredential": "BA",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "8208 FEATHERTOP RD SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87121-2090",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-350-8629",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8208 FEATHERTOP RD SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALBUQUERQUE",
"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-350-8629",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/01/2012",
"LastUpdateDate": "02/01/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "03-234454-00-6",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}