{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CORONADO COUNSELING CENTER- CLEAR LAKE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "1115 GEMINI ST STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOUSTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77058-2707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-461-6220",
"MailingAddressFaxNumber": "833-593-9064",
"FirstLinePracticeLocationAddress": "1115 GEMINI ST STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOUSTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77058-2707",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-461-6220",
"PracticeLocationAddressFaxNumber": "833-593-9064",
"EnumerationDate": "12/16/2018",
"LastUpdateDate": "01/23/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORONADO",
"AuthorizedOfficialFirstName": "CYNTHIA",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ED.D, CAS, LPC-S",
"AuthorizedOfficialTelephoneNumber": "281-512-1976",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}