{
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"OrgName": "PARKER COLLINS FAMILY MENTAL HEALTH, PLLC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "1056 CENTERVILLE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VADNAIS HEIGHTS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55127-6360",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-604-7771",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1056 CENTERVILLE CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VADNAIS HEIGHTS",
"PracticeLocationAddressStateName": "MN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-604-7771",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/14/2012",
"LastUpdateDate": "06/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HILL",
"AuthorizedOfficialFirstName": "JEFFREY",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "PSYD, LP",
"AuthorizedOfficialTelephoneNumber": "651-604-7771",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "LP5464",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}