{
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"FirstLineMailingAddress": "605 HOWARD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KALAMAZOO",
"MailingAddressStateName": "MI",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-373-6447",
"MailingAddressFaxNumber": "269-373-1229",
"FirstLinePracticeLocationAddress": "605 HOWARD ST",
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"PracticeLocationAddressFaxNumber": "269-373-1229",
"EnumerationDate": "02/05/2007",
"LastUpdateDate": "12/13/2007",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACK-POND",
"AuthorizedOfficialFirstName": "CONNIE",
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"AuthorizedOfficialCredential": "MA, LMSW, LPC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}