{
"Npi": {
"NPI": "1306025713",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FREDIN",
"FirstName": "RONALD",
"MiddleName": "CRAIG",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "MA, LPC, LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 752",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ABITA SPRINGS",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70420-0752",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "504-458-0361",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 SOUTH TYLER ST.",
"SecondLinePracticeLocationAddress": "SUITE 7A",
"PracticeLocationAddressCityName": "COVINGTON",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70433",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "504-458-0361",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/01/2007",
"LastUpdateDate": "11/01/2007",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "2414",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFT122",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}