{
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"FirstLineMailingAddress": "9009 NW 92ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YUKON",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73099-8424",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-249-1411",
"MailingAddressFaxNumber": "888-499-3569",
"FirstLinePracticeLocationAddress": "1601 HEALTH CENTER PARKWAY BUILDING 600",
"SecondLinePracticeLocationAddress": "SUITE 5",
"PracticeLocationAddressCityName": "YUKON",
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"PracticeLocationAddressTelephoneNumber": "405-249-1411",
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"EnumerationDate": "03/02/2018",
"LastUpdateDate": "05/01/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TATE",
"AuthorizedOfficialFirstName": "EMILY",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "LPC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "6737",
"LicenseNumberStateCode": "OK",
"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."
}
}
}
}