{
"Npi": {
"NPI": "1659806313",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COUNSELING CENTER OF BREVARD, LLC",
"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": "1413 S. PATRICK DR.",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "INDIAN HARBOUR BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32937",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-432-9282",
"MailingAddressFaxNumber": "321-777-5964",
"FirstLinePracticeLocationAddress": "1413 S PATRICK DR",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "INDIAN HARBOUR BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32937-4373",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-432-9282",
"PracticeLocationAddressFaxNumber": "321-777-5964",
"EnumerationDate": "05/01/2017",
"LastUpdateDate": "05/01/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAINTER",
"AuthorizedOfficialFirstName": "KARIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LMHC",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS",
"AuthorizedOfficialTelephoneNumber": "321-543-1185",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": "MH 13192",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}