{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "KELLY CASSADY COUNSELING SERVICES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7137 W WILLOW AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEORIA",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85381-6062",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-293-8527",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10451 W PALMERAS DR",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "SUN CITY",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85373-2011",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-293-8527",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/06/2012",
"LastUpdateDate": "10/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CASSADY",
"AuthorizedOfficialFirstName": "KELLY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER / COUNSELOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "623-293-8527",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "10235",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}