{
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"FirstLinePracticeLocationAddress": "15 OREGON AVE STE 111",
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"EnumerationDate": "04/10/2012",
"LastUpdateDate": "08/26/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": "01/04/2023",
"NPIReactivationDate": "06/18/2025",
"GenderCode": "F",
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"Taxonomies": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "LF60442328",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}