{
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"FirstLineMailingAddress": "2607 HODDAM RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAPERVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60564-5874",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-335-5187",
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"FirstLinePracticeLocationAddress": "4055 BOOK RD",
"SecondLinePracticeLocationAddress": "ALLELUIA LUTHERAN CHURCH",
"PracticeLocationAddressCityName": "NAPERVILLE",
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"PracticeLocationAddressTelephoneNumber": "630-904-3311",
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"EnumerationDate": "07/16/2010",
"LastUpdateDate": "07/16/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WACHTEL",
"AuthorizedOfficialFirstName": "AILI",
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"AuthorizedOfficialCredential": "LCPC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "180004420",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}