{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MINDFULNESS COUNSELING CENTER OF JACKSONVILLE",
"LastName": null,
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"Credential": null,
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"FirstLineMailingAddress": "2380 3RD ST S",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "JACKSONVILLE BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32250-4072",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-599-3099",
"MailingAddressFaxNumber": "904-713-2967",
"FirstLinePracticeLocationAddress": "2380 3RD ST S",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "JACKSONVILLE BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32250-4072",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-599-3099",
"PracticeLocationAddressFaxNumber": "904-713-2967",
"EnumerationDate": "10/24/2015",
"LastUpdateDate": "10/24/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "INGBER",
"AuthorizedOfficialFirstName": "JULIE",
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"AuthorizedOfficialTitle": "MENTAL HEALTH COUNSELOR",
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"AuthorizedOfficialCredential": "LMHC",
"AuthorizedOfficialTelephoneNumber": "904-686-5018",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "7855MH",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}