{
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JACKSON'S COUNSELING SERVICES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 314",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SWARTZ CREEK",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48473-0314",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-845-6465",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "G3163 FLUSHING RD",
"SecondLinePracticeLocationAddress": "SUITE 214",
"PracticeLocationAddressCityName": "FLINT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48504-4365",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-845-6465",
"PracticeLocationAddressFaxNumber": "810-733-7317",
"EnumerationDate": "08/14/2015",
"LastUpdateDate": "01/06/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACKSON",
"AuthorizedOfficialFirstName": "VALERIE",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "PROPRIETOR/PSYCHOTHERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMSW",
"AuthorizedOfficialTelephoneNumber": "810-845-6465",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "171M00000X",
"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": "6801077180",
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}