{
  "npi": "1689329112",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "LICSW",
    "authorized_official_first_name": "KATHLEEN",
    "authorized_official_last_name": "WALERYSZAK",
    "authorized_official_middle_name": "AMANDA",
    "authorized_official_name_prefix": "Mrs.",
    "authorized_official_telephone_number": "7076544325",
    "authorized_official_title_or_position": "Owner",
    "certification_date": "2022-02-14",
    "enumeration_date": "2022-02-14",
    "last_updated": "2022-02-14",
    "organization_name": "AMBER MOON WELLNESS, PLLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "8A RIDGEWOOD DR",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "KITTERY",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "630-883-0690",
      "postal_code": "039041046",
      "state": "ME",
      "telephone_number": "207-337-0456"
    },
    {
      "address_1": "426 STATE ST",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "PORTSMOUTH",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "630-883-0690",
      "postal_code": "038014049",
      "state": "NH",
      "telephone_number": "707-654-4325"
    }
  ],
  "taxonomies": [
    {
      "code": "261QM0801X",
      "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center",
    "certifying_board": "Accreditation Association for Ambulatory Health Care (AAAHC) / CMS",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "B4[14]",
        "medicare_type": "Community Mental Health Center"
      }
    ]
  }
}