{
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"FirstLineMailingAddress": "1070 DEVERON DR",
"SecondLineMailingAddress": null,
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"MailingAddressTelephoneNumber": "515-676-0745",
"MailingAddressFaxNumber": "712-458-4656",
"FirstLinePracticeLocationAddress": "1070 DEVERON DR",
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"PracticeLocationAddressCityName": "COUNCIL BLUFFS",
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"PracticeLocationAddressFaxNumber": "712-458-4656",
"EnumerationDate": "02/25/2026",
"LastUpdateDate": "02/25/2026",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROEDER",
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"AuthorizedOfficialCredential": "LMHC, LIMHP, LPC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Counselor",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}