{
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"EIN": null,
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"ParentOrgLBN": "LAURA GONZALES, LCSW",
"ParentOrgTIN": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1026 E WORTHY ST",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "GONZALES",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70737-4302",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-450-6616",
"MailingAddressFaxNumber": "225-450-6615",
"FirstLinePracticeLocationAddress": "1026 E WORTHY ST",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "GONZALES",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70737-4302",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "225-450-6616",
"PracticeLocationAddressFaxNumber": "225-450-6615",
"EnumerationDate": "04/08/2014",
"LastUpdateDate": "09/27/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALES",
"AuthorizedOfficialFirstName": "LAURA",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW, LCSW",
"AuthorizedOfficialTelephoneNumber": "225-450-6616",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "10953",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}