{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "GREYHAWK COUNSELING SERVICES, LLC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "6061 COLONIAL PKWY",
"SecondLineMailingAddress": "UNIT 6208",
"MailingAddressCityName": "GULF SHORES",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36542-2575",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "251-200-1567",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8141 STATE HIGHWAY 59",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "FOLEY",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36535-3869",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "251-200-1567",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/12/2016",
"LastUpdateDate": "10/12/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "UNDERWOOD",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "WALTER",
"AuthorizedOfficialTitle": "CEO/OWNER/LICENSED PSYCHOTHERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "251-200-1567",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "437",
"LicenseNumberStateCode": "AL",
"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."
}
}
}
}