{
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"EIN": null,
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"OrgName": "LAURA PEITZ COUNSELING SERVICES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "1912 LAKE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PONCA CITY",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74604-4800",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-762-6511",
"MailingAddressFaxNumber": "580-762-6511",
"FirstLinePracticeLocationAddress": "1912 LAKE RD",
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"PracticeLocationAddressCityName": "PONCA CITY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-762-6511",
"PracticeLocationAddressFaxNumber": "580-762-6511",
"EnumerationDate": "08/03/2012",
"LastUpdateDate": "08/03/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PEITZ",
"AuthorizedOfficialFirstName": "LAURA",
"AuthorizedOfficialMiddleName": "ANNE",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "580-763-2802",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "3813",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}