{
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"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "237 N CENTRAL AVE STE C",
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"MailingAddressCityName": "GLENDALE",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "237 N CENTRAL AVE",
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"PracticeLocationAddressCityName": "GLENDALE",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-547-9544",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/29/2016",
"LastUpdateDate": "01/24/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
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"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}