{
"Npi": {
"NPI": "1891559548",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DANFORTH",
"FirstName": "JACK",
"MiddleName": "RAMSDELL",
"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": "1055 N PARK AVE UNIT 322",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TUCSON",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85719-4430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-396-7682",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1517 HIGHWAY 13 E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURNSVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55337-2917",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-756-9107",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/12/2024",
"LastUpdateDate": "02/21/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "02/13/2024",
"NPIReactivationDate": "02/21/2024",
"GenderCode": "M",
"Gender": "Male",
"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": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106S00000X",
"TaxonomyName": "Behavior Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}