{
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "GORDY J WHITCOMB",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1481 COUNTY ROAD 29",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEKAMAH",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68061-5030",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-374-0245",
"MailingAddressFaxNumber": "402-564-7735",
"FirstLinePracticeLocationAddress": "748 N MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREMONT",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68025-5004",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-374-0245",
"PracticeLocationAddressFaxNumber": "402-564-7735",
"EnumerationDate": "12/07/2016",
"LastUpdateDate": "12/07/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITCOMF",
"AuthorizedOfficialFirstName": "GORDY",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER/OPERATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMHP LADC",
"AuthorizedOfficialTelephoneNumber": "402-374-0245",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "436",
"LicenseNumberStateCode": "NE",
"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."
}
}
}
}