{
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"NamePrefix": null,
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"FirstLineMailingAddress": "745 CRAIG RD STE 206",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CREVE COEUR",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63141-7122",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-409-2362",
"MailingAddressFaxNumber": "314-432-7500",
"FirstLinePracticeLocationAddress": "745 CRAIG RD",
"SecondLinePracticeLocationAddress": "SUITE 206",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-409-2362",
"PracticeLocationAddressFaxNumber": "314-432-7500",
"EnumerationDate": "08/18/2011",
"LastUpdateDate": "10/16/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPENCER-STEELE",
"AuthorizedOfficialFirstName": "LUANN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COUNSELOR",
"AuthorizedOfficialNamePrefix": "MRS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "314-409-2362",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Professional Counselor",
"LicenseNumber": "001749",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}