{
"Npi": {
"NPI": "1922459007",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLORADO MESA UNIVERSITY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1100 NORTH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND JUNCTION",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81501-3122",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-248-1654",
"MailingAddressFaxNumber": "970-248-1550",
"FirstLinePracticeLocationAddress": "1100 NORTH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND JUNCTION",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81501-3122",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-248-1654",
"PracticeLocationAddressFaxNumber": "970-248-1550",
"EnumerationDate": "06/29/2016",
"LastUpdateDate": "06/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LANG",
"AuthorizedOfficialFirstName": "BOB",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "DIRECTOR OF DAH",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC, LAC",
"AuthorizedOfficialTelephoneNumber": "970-201-8472",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "LPC4881",
"LicenseNumberStateCode": "CO",
"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."
}
}
}
}