{
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"EIN": null,
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"NameSuffix": "III",
"Credential": "LMFT",
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"OtherOrgNameTypeCode": null,
"OtherLastName": "LESLIE",
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"OtherCredential": "LMFT",
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"FirstLineMailingAddress": "6310 SAN VICENTE BLVD",
"SecondLineMailingAddress": "SUITE 410",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90048-5426",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "213-694-1616",
"MailingAddressFaxNumber": "323-666-8728",
"FirstLinePracticeLocationAddress": "6310 SAN VICENTE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 410",
"PracticeLocationAddressCityName": "LOS ANGELES",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "213-694-1616",
"PracticeLocationAddressFaxNumber": "323-666-8728",
"EnumerationDate": "05/05/2008",
"LastUpdateDate": "05/05/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC36944",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}