{
"Npi": {
"NPI": "1588721997",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HILEMAN",
"FirstName": "JACK",
"MiddleName": "L",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HILEMAN",
"OtherFirstName": "JACK",
"OtherMiddleName": "L",
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "LMFT",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1451 S ELM EUGENE ST UNIT 54",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENSBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27406-2392",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-202-0846",
"MailingAddressFaxNumber": "866-420-9205",
"FirstLinePracticeLocationAddress": "1451 S ELM EUGENE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27406-2200",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-202-0846",
"PracticeLocationAddressFaxNumber": "866-420-9205",
"EnumerationDate": "01/03/2007",
"LastUpdateDate": "06/24/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "1091",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}