{
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"FirstLineMailingAddress": "PO BOX 120448",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55112-0018",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "763-300-0387",
"MailingAddressFaxNumber": "763-340-2340",
"FirstLinePracticeLocationAddress": "1030 COUNTY ROAD E W STE 220",
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"PracticeLocationAddressCityName": "SHOREVIEW",
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"PracticeLocationAddressTelephoneNumber": "763-340-2311",
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"EnumerationDate": "04/25/2023",
"LastUpdateDate": "10/17/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURNS",
"AuthorizedOfficialFirstName": "RICHARD",
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"AuthorizedOfficialCredential": "MS, LMFT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}