{
"Npi": {
"NPI": "1023284320",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHILDREN'S HAVEN COUNSELING SERVICES",
"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": "PO BOX 24511",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76124-1511",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-446-5591",
"MailingAddressFaxNumber": "817-446-5591",
"FirstLinePracticeLocationAddress": "4200 SOUTH FWY STE 604",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76115-1402",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-446-5591",
"PracticeLocationAddressFaxNumber": "817-446-5591",
"EnumerationDate": "05/06/2008",
"LastUpdateDate": "05/06/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RANDOLPH AUVENSHINE",
"AuthorizedOfficialFirstName": "MONICA",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR/OWN",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA, LPC",
"AuthorizedOfficialTelephoneNumber": "817-446-5591",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "19708",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}