{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MOENKOPI COUNSELING PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2177 ALISON ROW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT GEORGE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84790-8306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "435-817-9780",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "230 N 1680 E STE H2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT GEORGE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84790-2585",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "435-773-8909",
"PracticeLocationAddressFaxNumber": "435-673-5710",
"EnumerationDate": "04/19/2018",
"LastUpdateDate": "11/01/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RICHARDS",
"AuthorizedOfficialFirstName": "ALLEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "435-817-9780",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}