{
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"OrgName": "PETER M LISIECKI PHD PC INC",
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"FirstLineMailingAddress": "7960 GRAND RIVER RD STE 120",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRIGHTON",
"MailingAddressStateName": "MI",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "7960 W. GRAND RIVER",
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"PracticeLocationAddressFaxNumber": "810-225-2265",
"EnumerationDate": "02/12/2007",
"LastUpdateDate": "06/17/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LISIECKI",
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"AuthorizedOfficialTelephoneNumber": "810-227-1999",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychologist",
"LicenseNumber": "6301003173",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}