{
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"EIN": null,
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"OrgName": "MARK SMITH, PROFESSIONAL SERVICES, LLC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "14825 E 42ND ST S",
"SecondLineMailingAddress": "SUITE 208",
"MailingAddressCityName": "INDEPENDENCE",
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"MailingAddressPostalCode": "64055-4776",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-353-5363",
"MailingAddressFaxNumber": "816-295-6100",
"FirstLinePracticeLocationAddress": "14825 E 42ND ST S",
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"PracticeLocationAddressCityName": "INDEPENDENCE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "816-353-5363",
"PracticeLocationAddressFaxNumber": "816-295-6100",
"EnumerationDate": "12/04/2008",
"LastUpdateDate": "05/01/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "LESLIE",
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"AuthorizedOfficialCredential": "L.C.S.W.",
"AuthorizedOfficialTelephoneNumber": "816-353-5363",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "002326",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}