{
"Npi": {
"NPI": "1114738499",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JACKSON HEALING",
"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": "2020 CASCADE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49203-3810",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-581-4710",
"MailingAddressFaxNumber": "517-905-5906",
"FirstLinePracticeLocationAddress": "720 W FRANKLIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49201-1674",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-726-4038",
"PracticeLocationAddressFaxNumber": "517-905-5906",
"EnumerationDate": "01/16/2025",
"LastUpdateDate": "01/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOOLSBY",
"AuthorizedOfficialFirstName": "HEATHER",
"AuthorizedOfficialMiddleName": "RENEE",
"AuthorizedOfficialTitle": "MASTER CLINICICAN",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA, LPC, NCC, CPT-C",
"AuthorizedOfficialTelephoneNumber": "517-581-4710",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}