{
"Npi": {
"NPI": "1982246500",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SKY CIRCLES HEALING ARTS PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"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": "20126 BALLINGER WAY NE # 274",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHORELINE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98155-1117",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-706-2932",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1840 NW 202ND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHORELINE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98177-2247",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-706-2932",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/15/2019",
"LastUpdateDate": "12/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUDELMAN",
"AuthorizedOfficialFirstName": "SHANNON",
"AuthorizedOfficialMiddleName": "NICOLE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "206-706-2932",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}