{
"Npi": {
"NPI": "1689134074",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PORTAL POINT COUNSELING, 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": "2178 BYRON SHORES DR SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BYRON CENTER",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49315-8087",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-299-8787",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2663 44TH ST SW STE 106",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WYOMING",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49519-4189",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-299-8789",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/21/2019",
"LastUpdateDate": "03/21/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VANBUSKIRK",
"AuthorizedOfficialFirstName": "RACHEL",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMSW",
"AuthorizedOfficialTelephoneNumber": "616-299-8789",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}