{
"Npi": {
"NPI": "1871642736",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GENTRY",
"FirstName": "ELECTRA",
"MiddleName": "UNIKA",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "L.C.S.W.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GENTRY-GOODWIN",
"OtherFirstName": "ELECTRA",
"OtherMiddleName": "UNIKA",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "L.C.S.W.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "4971 HOLLICE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LIVERMORE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94550-8509",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "925-606-5669",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 MUIR RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARTINEZ",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94553-4614",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-313-4836",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/09/2007",
"LastUpdateDate": "01/11/2022",
"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": "23257",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}