{
"Npi": {
"NPI": "1013161009",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SABO",
"FirstName": "JACQUELINE",
"MiddleName": "W",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "WILDFLOWER COUNSELING, LLC",
"SecondLineMailingAddress": "1123 12TH AVE RD, #274",
"MailingAddressCityName": "NAMPA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83686-5738",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-315-6640",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "WILDFLOWER COUNSELING, LLC",
"SecondLinePracticeLocationAddress": "104 9TH AVE S STE B2",
"PracticeLocationAddressCityName": "NAMPA",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83651-3809",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-993-0559",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/04/2008",
"LastUpdateDate": "06/10/2021",
"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": "LCPC-4151",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}