{
"Npi": {
"NPI": "1386604577",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTER FOR PSYCHOLOGICAL SERVICES - OAK LAWN LTD",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10735 S CICERO AVE",
"SecondLineMailingAddress": "SUITE 208",
"MailingAddressCityName": "OAK LAWN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60453-5400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-424-0001",
"MailingAddressFaxNumber": "708-424-1394",
"FirstLinePracticeLocationAddress": "10735 S CICERO AVE",
"SecondLinePracticeLocationAddress": "SUITE 208",
"PracticeLocationAddressCityName": "OAK LAWN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60453-5400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-424-0001",
"PracticeLocationAddressFaxNumber": "708-424-1394",
"EnumerationDate": "03/23/2006",
"LastUpdateDate": "04/17/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "VICTORIA",
"AuthorizedOfficialMiddleName": "KOWALSKY",
"AuthorizedOfficialTitle": "OWNER AND HEAD OF THE PRACTICE",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSYD",
"AuthorizedOfficialTelephoneNumber": "708-424-0001",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "071 003598",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}