{
"Npi": {
"NPI": "1932788643",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "YOUNG",
"FirstName": "MEGAN",
"MiddleName": "REBECCA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW-S",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3001 BLACK HILLS BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HEATH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75126-0615",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-425-6316",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "205 E US HIGHWAY 80",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORNEY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75126-8604",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-730-6650",
"PracticeLocationAddressFaxNumber": "945-468-7343",
"EnumerationDate": "04/08/2021",
"LastUpdateDate": "08/06/2024",
"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": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "66863",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}