{
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"FirstLineMailingAddress": "14900 MAGNOLIA BLVD",
"SecondLineMailingAddress": "PO BOX 5552",
"MailingAddressCityName": "SHERMAN OAKS",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "280 E THOUSAND OAKS BLVD STE D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THOUSAND OAKS",
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"PracticeLocationAddressTelephoneNumber": "805-341-5737",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/18/2020",
"LastUpdateDate": "04/13/2023",
"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": "139081",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}