{
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"EIN": null,
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"OrgName": "WEST COAST THERAPY COLLECTIVE, A LICENSED MARRIAGE & FAMILY THERAPY CO",
"LastName": null,
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"FirstLineMailingAddress": "171 SAXONY RD STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ENCINITAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92024-6776",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-724-3805",
"MailingAddressFaxNumber": "844-594-2433",
"FirstLinePracticeLocationAddress": "171 SAXONY RD STE 104",
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"PracticeLocationAddressCityName": "ENCINITAS",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-724-3805",
"PracticeLocationAddressFaxNumber": "844-594-2433",
"EnumerationDate": "10/28/2019",
"LastUpdateDate": "10/28/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHRINKLE",
"AuthorizedOfficialFirstName": "SUSAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "760-613-7073",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}