{
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"EIN": null,
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"FirstLineMailingAddress": "1115 D ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RAMONA",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1115 D ST",
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"PracticeLocationAddressCityName": "RAMONA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-580-7756",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/07/2017",
"LastUpdateDate": "02/07/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "LMFT 14570",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}