{
"Npi": {
"NPI": "1962790121",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KLA COUNSELING SERVICES, INC.",
"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": "4653 SW BERMUDA WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALM CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34990-1220",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "772-233-4282",
"MailingAddressFaxNumber": "772-248-1358",
"FirstLinePracticeLocationAddress": "850 NW FEDERAL HWY",
"SecondLinePracticeLocationAddress": "SUITE 111",
"PracticeLocationAddressCityName": "STUART",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34994-1019",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-233-4282",
"PracticeLocationAddressFaxNumber": "772-248-1358",
"EnumerationDate": "07/21/2011",
"LastUpdateDate": "07/21/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AGULIA",
"AuthorizedOfficialFirstName": "KELLIE",
"AuthorizedOfficialMiddleName": "PARRIS",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS, LMHC",
"AuthorizedOfficialTelephoneNumber": "772-233-4282",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "MH 9214",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}