{
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "520 TALBOTT ST STE 3",
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"EnumerationDate": "09/21/2006",
"LastUpdateDate": "12/03/2020",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "WHITE",
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"AuthorizedOfficialTelephoneNumber": "641-648-4631",
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"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
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}
},
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}
}