{
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"FirstLineMailingAddress": "29042 SILVERDALE LN",
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"MailingAddressCityName": "WINCHESTER",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-607-1234",
"MailingAddressFaxNumber": "951-527-1401",
"FirstLinePracticeLocationAddress": "41661 ENTERPRISE CIR N STE 111",
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"PracticeLocationAddressCityName": "TEMECULA",
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"EnumerationDate": "03/28/2022",
"LastUpdateDate": "10/24/2022",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROUSSARD",
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"AuthorizedOfficialCredential": "LMFT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}