{
"Npi": {
"NPI": "1922267475",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUL CHOICE COUNSELING, LTD",
"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": "831 FOREST AVE",
"SecondLineMailingAddress": "#3W",
"MailingAddressCityName": "EVANSTON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60202-2486",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-328-8477",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "831 FOREST AVE APT 3W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EVANSTON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60202-2421",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-332-5471",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/09/2008",
"LastUpdateDate": "06/12/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RYNOR",
"AuthorizedOfficialFirstName": "ALYSE",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.C.S.W.",
"AuthorizedOfficialTelephoneNumber": "847-328-8477",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "149006701",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}