{
"Npi": {
"NPI": "1780261552",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GREEN",
"FirstName": "AMBER",
"MiddleName": "JANIELLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LATSON",
"OtherFirstName": "AMBER",
"OtherMiddleName": "JANIELLE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "9718 AIELLO LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREVEPORT",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71106-7440",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-638-9945",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2912 VALLEY VIEW DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHREVEPORT",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71108-4934",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-626-7143",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/26/2021",
"LastUpdateDate": "01/03/2023",
"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": "171M00000X",
"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": "PLC8418",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "PLC8418",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}