{
"Npi": {
"NPI": "1821326158",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOUNDARIES FAMILY COUNSELING &LICENSED CLINICAL SOCIAL WORKER CORP.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "105 N ROSE ST",
"SecondLineMailingAddress": "STE. 211",
"MailingAddressCityName": "ESCONDIDO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92027-7222",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-705-8468",
"MailingAddressFaxNumber": "760-735-2922",
"FirstLinePracticeLocationAddress": "135 E 3RD AVE",
"SecondLinePracticeLocationAddress": "STE. B",
"PracticeLocationAddressCityName": "ESCONDIDO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92025-4252",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-705-8468",
"PracticeLocationAddressFaxNumber": "760-735-2922",
"EnumerationDate": "11/24/2009",
"LastUpdateDate": "02/02/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HASTINGS GINES",
"AuthorizedOfficialFirstName": "HOLLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "858-212-4454",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "LCS 20560",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}