{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LIFE QUEST MINISTRY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12505 GRANDVIEW RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRANDVIEW",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64030-1703",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-765-8211",
"MailingAddressFaxNumber": "816-765-8215",
"FirstLinePracticeLocationAddress": "12505 GRANDVIEW RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRANDVIEW",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "64030-1703",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "816-765-8211",
"PracticeLocationAddressFaxNumber": "816-765-8215",
"EnumerationDate": "11/29/2012",
"LastUpdateDate": "11/29/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITE",
"AuthorizedOfficialFirstName": "KEITH",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "VICE-PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA LPC",
"AuthorizedOfficialTelephoneNumber": "816-765-8211",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "2001013216",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}