{
"Npi": {
"NPI": "1215121967",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAMILY BEHAVIORAL RESOURCES, LLC",
"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": "2301 RIVERSIDE DR",
"SecondLineMailingAddress": "SUITE 8",
"MailingAddressCityName": "GREEN BAY",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54301-1907",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-430-9100",
"MailingAddressFaxNumber": "920-430-9101",
"FirstLinePracticeLocationAddress": "2301 RIVERSIDE DR",
"SecondLinePracticeLocationAddress": "SUITE 8",
"PracticeLocationAddressCityName": "GREEN BAY",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54301-1907",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-430-9100",
"PracticeLocationAddressFaxNumber": "920-430-9101",
"EnumerationDate": "09/05/2007",
"LastUpdateDate": "09/05/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURKS",
"AuthorizedOfficialFirstName": "CAROL",
"AuthorizedOfficialMiddleName": "JEAN",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS, LPC",
"AuthorizedOfficialTelephoneNumber": "920-430-9100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "2480",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}