{
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"FirstLineMailingAddress": "431 OHIO PIKE STE 198S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CINCINNATI",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45255-3637",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "513-770-1705",
"MailingAddressFaxNumber": "513-770-1705",
"FirstLinePracticeLocationAddress": "431 OHIO PIKE STE 198S",
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"PracticeLocationAddressCityName": "CINCINNATI",
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"PracticeLocationAddressTelephoneNumber": "513-770-1705",
"PracticeLocationAddressFaxNumber": "513-770-1705",
"EnumerationDate": "04/20/2016",
"LastUpdateDate": "01/18/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUBBELL",
"AuthorizedOfficialFirstName": "CRYSTAL",
"AuthorizedOfficialMiddleName": "A",
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"AuthorizedOfficialCredential": "L.P.C.C. SUPV",
"AuthorizedOfficialTelephoneNumber": "513-770-1705",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "E.1100061 SUPV",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}