{
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"OrgName": "CROSSROADS CHRISTIAN CENTER",
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"FirstLineMailingAddress": "4165 SHORELINE DR",
"SecondLineMailingAddress": "SUITE 15",
"MailingAddressCityName": "SPRING PARK",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55384-9659",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-747-7224",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4165 SHORELINE DR",
"SecondLinePracticeLocationAddress": "SUITE 15",
"PracticeLocationAddressCityName": "SPRING PARK",
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"PracticeLocationAddressTelephoneNumber": "612-747-7224",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/03/2012",
"LastUpdateDate": "12/03/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KULLBERG",
"AuthorizedOfficialFirstName": "DEBRA",
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"AuthorizedOfficialTitle": "LICENSED MARRIAGE/ FAMILY THERAPIST",
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"AuthorizedOfficialCredential": "L.M.F.T.",
"AuthorizedOfficialTelephoneNumber": "612-747-7224",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "1886",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}