{
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"OrgName": "ANGELA DIXON COUNSELING",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "633 N DOREEN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WICHITA",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "67206-1621",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "316-519-8479",
"MailingAddressFaxNumber": "316-816-1792",
"FirstLinePracticeLocationAddress": "111 S WHITTIER RD # 4000B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WICHITA",
"PracticeLocationAddressStateName": "KS",
"PracticeLocationAddressPostalCode": "67207-1045",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "316-689-4211",
"PracticeLocationAddressFaxNumber": "316-816-1792",
"EnumerationDate": "08/08/2017",
"LastUpdateDate": "02/02/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIXON",
"AuthorizedOfficialFirstName": "ANGELA",
"AuthorizedOfficialMiddleName": "BETH",
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"AuthorizedOfficialCredential": "LCMFT",
"AuthorizedOfficialTelephoneNumber": "316-519-8479",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "316",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}