{
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"FirstLineMailingAddress": "2591 FAIR OAKS AVE # 103",
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"MailingAddressCityName": "ALTADENA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "225 W BROADWAY STE 155",
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"PracticeLocationAddressCityName": "GLENDALE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-333-8293",
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"EnumerationDate": "05/12/2023",
"LastUpdateDate": "06/15/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "138162",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}