{
"Npi": {
"NPI": "1578881918",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HALES COUNSELING CENTER, PLLC",
"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": "65 N MAIN ST",
"SecondLineMailingAddress": "UNIT 667",
"MailingAddressCityName": "TOOELE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84074-2217",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-783-9265",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "36 N MAIN ST",
"SecondLinePracticeLocationAddress": "12",
"PracticeLocationAddressCityName": "TOOELE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84074-2100",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-783-9265",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/10/2010",
"LastUpdateDate": "03/03/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HALES",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "801-783-9265",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "75934640162",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}