{
"Npi": {
"NPI": "1922435668",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WAGNER",
"FirstName": "SARAH",
"MiddleName": "J",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MS, LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GRIMES",
"OtherFirstName": "SARAH",
"OtherMiddleName": "J",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MS, LPC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "127 S MCKEAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BUTLER",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16001-6029",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-991-1289",
"MailingAddressFaxNumber": "724-498-0527",
"FirstLinePracticeLocationAddress": "371 NORTH MAIN STREET",
"SecondLinePracticeLocationAddress": "SECOND FLOOR",
"PracticeLocationAddressCityName": "BUTLER",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-991-1289",
"PracticeLocationAddressFaxNumber": "724-241-3568",
"EnumerationDate": "09/26/2013",
"LastUpdateDate": "08/01/2019",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "PC007100",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}