{
"Npi": {
"NPI": "1255195558",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MISKOKOMON",
"FirstName": "TABITHA",
"MiddleName": "NICOLE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LLPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7 LESLIE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT CLEMENS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48043-2332",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-260-4209",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "36975 UTICA RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLINTON TOWNSHIP",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48036-1685",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-260-4209",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/08/2024",
"LastUpdateDate": "02/08/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "6451023453",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}