{
"Npi": {
"NPI": "1831663814",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NELSON",
"FirstName": "KATIE",
"MiddleName": "LYNN",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "MA, LPCC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BURGGRAFF",
"OtherFirstName": "KATIE",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "MA, LPCC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "12580 192ND CT NW STE F",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELK RIVER",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55330-5085",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-251-1546",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "23 PINE ST N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MORA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55051-1320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "320-679-6964",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/14/2019",
"LastUpdateDate": "12/18/2024",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "CC02027",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}