{
"Npi": {
"NPI": "1740306695",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FISHER-SZELES",
"FirstName": "TRINA",
"MiddleName": "CHRISTEEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FISHER",
"OtherFirstName": "TRINA",
"OtherMiddleName": "CHRISTEEN",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "LCSW",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1121 E STATE ST",
"SecondLineMailingAddress": "STE 107",
"MailingAddressCityName": "EAGLE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83616-6062",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-850-7958",
"MailingAddressFaxNumber": "208-441-9947",
"FirstLinePracticeLocationAddress": "1121 E STATE ST",
"SecondLinePracticeLocationAddress": "STE 107",
"PracticeLocationAddressCityName": "EAGLE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83616-6062",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-850-7958",
"PracticeLocationAddressFaxNumber": "208-441-9947",
"EnumerationDate": "03/22/2007",
"LastUpdateDate": "05/29/2008",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "LCSW-25346",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}