{
"Npi": {
"NPI": "1538509690",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LEVERENCE",
"FirstName": "MICHELLE",
"MiddleName": "LOUISE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FREDRICK",
"OtherFirstName": "MICHELLE",
"OtherMiddleName": "LOUISE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "7310 E RYAN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILTON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53563-9358",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "608-868-6885",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "712 SUMMIT AVE STE 714",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCONOMOWOC",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53066-3827",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-226-2006",
"PracticeLocationAddressFaxNumber": "262-226-2462",
"EnumerationDate": "07/03/2013",
"LastUpdateDate": "01/17/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "4864-125",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}