{
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"OtherCredential": "EVELYN CO MFT",
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"FirstLineMailingAddress": "15714 HALLDALE AVE APT B",
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"FirstLinePracticeLocationAddress": "13323 W WASHINGTON BLVD STE 200",
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"PracticeLocationAddressCityName": "LOS ANGELES",
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"PracticeLocationAddressTelephoneNumber": "800-803-4584",
"PracticeLocationAddressFaxNumber": "800-803-4584",
"EnumerationDate": "03/23/2007",
"LastUpdateDate": "09/29/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC 44330",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}