{
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"FirstLineMailingAddress": "2621 GREEN RIVER RD # 105-151",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4181 FLAT ROCK DR STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERSIDE",
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"PracticeLocationAddressTelephoneNumber": "909-777-9798",
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"EnumerationDate": "11/11/2022",
"LastUpdateDate": "11/11/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUMMERS",
"AuthorizedOfficialFirstName": "MARK",
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"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": "LMFT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}