{
"Npi": {
"NPI": "1023386117",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLAD SERVICES COUNSELING AND COACHING CENTER",
"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": "1110 SNYDER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST LAWN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19609-1151",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-678-7300",
"MailingAddressFaxNumber": "610-678-3698",
"FirstLinePracticeLocationAddress": "4 WELLINGTON BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WYOMISSING",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19610-1850",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-678-0266",
"PracticeLocationAddressFaxNumber": "610-678-3698",
"EnumerationDate": "12/05/2011",
"LastUpdateDate": "03/19/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DERRER",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.M.F.T",
"AuthorizedOfficialTelephoneNumber": "610-678-7300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MF000592",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}