{
"Npi": {
"NPI": "1871045385",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOLINA PSYCHOLOGICAL CONSULTANTS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2102 BUSINESS CENTER DR",
"SecondLineMailingAddress": "SUITE 130",
"MailingAddressCityName": "IRVINE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92612-1001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-267-4424",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18 MONROVIA",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IRVINE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92602-0925",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-267-4424",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/31/2016",
"LastUpdateDate": "10/31/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOLINA",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LICENSED PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "714-267-4424",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "273R00000X",
"TaxonomyName": "Psychiatric Hospital Unit",
"LicenseNumber": "PSY 18195",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}