{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "JAYA MATHEW PHD, PLLC",
"LastName": null,
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"MiddleName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "1340 PRUDENTIAL DR",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75235-4115",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-755-7532",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1340 PRUDENTIAL DR",
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"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressTelephoneNumber": "214-755-7532",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/05/2017",
"LastUpdateDate": "05/05/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATHEW",
"AuthorizedOfficialFirstName": "JAYA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "214-755-7532",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychologist",
"LicenseNumber": "36584",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}