{
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"FirstLineMailingAddress": "PO BOX 435",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AGOURA HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91376-0435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-384-3115",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "23632 CALABASAS ROAD",
"SecondLinePracticeLocationAddress": "SUITE #103",
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"EnumerationDate": "08/16/2011",
"LastUpdateDate": "08/16/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
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"AuthorizedOfficialCredential": "PSY. D.",
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"Taxonomies": {
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"TaxonomyName": "Community/Behavioral Health Agency",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}