{
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "411 3RD ST SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OSSEO",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55369-1606",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "763-600-7572",
"MailingAddressFaxNumber": "844-407-4565",
"FirstLinePracticeLocationAddress": "1935 COUNTY ROAD B2 W STE 240",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55113-2722",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-590-5752",
"PracticeLocationAddressFaxNumber": "844-407-4565",
"EnumerationDate": "07/26/2017",
"LastUpdateDate": "02/05/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ADAMS",
"AuthorizedOfficialFirstName": "REBECCA",
"AuthorizedOfficialMiddleName": "JOY",
"AuthorizedOfficialTitle": "MARRIAGE AND FAMILY THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA, LMFT",
"AuthorizedOfficialTelephoneNumber": "763-600-7572",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "2062",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}