{
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"EIN": null,
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"FirstLineMailingAddress": "570 FUNSTON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN LUIS OBISPO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93401-5683",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-235-2800",
"MailingAddressFaxNumber": "805-439-2487",
"FirstLinePracticeLocationAddress": "11549 LOS OSOS VALLEY RD",
"SecondLinePracticeLocationAddress": "SUITE 200",
"PracticeLocationAddressCityName": "SAN LUIS OBISPO",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-235-2800",
"PracticeLocationAddressFaxNumber": "805-439-2487",
"EnumerationDate": "07/28/2016",
"LastUpdateDate": "07/28/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEFRISCO",
"AuthorizedOfficialFirstName": "PAULA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "805-235-2800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LCS27899",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}