{
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"IsOrgSubpart": "N",
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"OrgName": "FAMILY SERVICES OF NORTHEAST WI, INC",
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"FirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3430 SPIRIT WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREEN BAY",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54304-5687",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-330-0339",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3430 SPIRIT WAY",
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"PracticeLocationAddressCityName": "GREEN BAY",
"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-330-0339",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/17/2007",
"LastUpdateDate": "09/17/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JENSEN",
"AuthorizedOfficialFirstName": "KATHERINE",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "920-330-0339",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Counselor",
"LicenseNumber": "3851-125",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}