{
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"EIN": null,
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"Credential": "LMFT",
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"OtherLastName": "DHARA",
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"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "E2498 350TH AVE.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENOMONIE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54751-6212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-726-1688",
"MailingAddressFaxNumber": "207-708-5352",
"FirstLinePracticeLocationAddress": "E2498 350TH AVE.",
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"PracticeLocationAddressCityName": "MENOMONIE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-726-1688",
"PracticeLocationAddressFaxNumber": "207-708-5352",
"EnumerationDate": "06/27/2017",
"LastUpdateDate": "06/19/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "571-228",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}