{
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"FirstLineMailingAddress": "27198 WOODHOLLOW RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT DORA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32757-9615",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-227-9245",
"MailingAddressFaxNumber": "352-735-1551",
"FirstLinePracticeLocationAddress": "115 E 4TH AVE STE 206",
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"PracticeLocationAddressCityName": "MOUNT DORA",
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"EnumerationDate": "01/15/2015",
"LastUpdateDate": "01/15/2015",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAPSTRAW",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": "WESTBROOK",
"AuthorizedOfficialTitle": "OWNER/ MARRIAGE AND FAMILY THERAPIS",
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"AuthorizedOfficialCredential": "LMFT",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"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."
}
}
}
}