{
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"FirstLineMailingAddress": "1600 S KINGSHIGHWAY BLVD STE 1N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT LOUIS",
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"MailingAddressPostalCode": "63110-2246",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-932-0900",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1600 S KINGSHIGHWAY BLVD STE 1N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT LOUIS",
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"PracticeLocationAddressTelephoneNumber": "314-932-0900",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/14/2023",
"LastUpdateDate": "04/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COLLINS",
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"AuthorizedOfficialCredential": "MSW LCSW",
"AuthorizedOfficialTelephoneNumber": "314-932-0900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}