{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "THERAPY AND CONSULTATION SERVICES",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2000 SPRING GARDEN ST",
"SecondLineMailingAddress": "1 FRONT OFFICE",
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19130-3994",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-330-0404",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2000 SPRING GARDEN ST",
"SecondLinePracticeLocationAddress": "1 FRONT OFFICE",
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-330-0404",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/17/2017",
"LastUpdateDate": "04/17/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COTTOM",
"AuthorizedOfficialFirstName": "JACK",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "404-918-6042",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "PC009399",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}