{
"Npi": {
"NPI": "1174671861",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MCQUEEN",
"FirstName": "ROBERT",
"MiddleName": "C",
"NamePrefix": "MR.",
"NameSuffix": "JR.",
"Credential": "LMHC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCQUEEN",
"OtherFirstName": "BOB",
"OtherMiddleName": null,
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "LMHC",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "7985 COLEE COVE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ST AUGUSTINE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32092-2306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-651-3237",
"MailingAddressFaxNumber": "904-217-8623",
"FirstLinePracticeLocationAddress": "4711 HWY 17S.",
"SecondLinePracticeLocationAddress": "STE. C-4",
"PracticeLocationAddressCityName": "ORANGE PARK",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32003",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-651-3237",
"PracticeLocationAddressFaxNumber": "904-217-8623",
"EnumerationDate": "01/08/2007",
"LastUpdateDate": "04/26/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "1808",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "MH-4271",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}