{
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"OrgName": "YOUR PLACE COUNSELING SERVICES",
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"FirstLineMailingAddress": "404 N MAIN ST",
"SecondLineMailingAddress": "SUITE 507",
"MailingAddressCityName": "OSHKOSH",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54901-4957",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-230-2363",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "404 N MAIN ST",
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"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressTelephoneNumber": "920-230-2363",
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"EnumerationDate": "11/19/2013",
"LastUpdateDate": "11/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHMIDT",
"AuthorizedOfficialFirstName": "ANGELA",
"AuthorizedOfficialMiddleName": "EVA",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LPC",
"AuthorizedOfficialTelephoneNumber": "414-315-9323",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "5077125",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}