{
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"EIN": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "18302 IRVINE BLVD",
"SecondLineMailingAddress": "SUITE 300",
"MailingAddressCityName": "TUSTIN",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18302 IRVINE BLVD.",
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"PracticeLocationAddressCityName": "TUSTN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-957-1004",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/27/2007",
"LastUpdateDate": "11/21/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "49955",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}