{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "SARAH TILLEY LMHC LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3803 WHITEHEAD BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PANAMA CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32404-4102",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-753-1939",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "400 THOMAS DRIVE",
"SecondLinePracticeLocationAddress": "UNIT 7108",
"PracticeLocationAddressCityName": "PANAMA CITY BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32408",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "515-373-8391",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/20/2018",
"LastUpdateDate": "07/20/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TILLEY",
"AuthorizedOfficialFirstName": "SARAH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMHC",
"AuthorizedOfficialTelephoneNumber": "515-373-8391",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "16517",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}