{
"Npi": {
"NPI": "1326829631",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JENNIFER GAUVIN LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "21456 SUMMERSIDE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTHVILLE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48167-1026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-719-4498",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "164 N MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLYMOUTH",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48170-1236",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-335-0431",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/12/2023",
"LastUpdateDate": "03/20/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAUVIN",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "SOLE MEMBER / AUTHORIZED OFFICIAL",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMSW",
"AuthorizedOfficialTelephoneNumber": "586-719-4498",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}