{
"Npi": {
"NPI": "1538698295",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COUNSELING CENTER FOR GROWTH AND DEVELOPMENT; A PROFESSIONAL MARRIAGE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "602 COMMERCE AVE STE E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALMDALE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93551-3882",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "661-810-3671",
"MailingAddressFaxNumber": "818-302-2101",
"FirstLinePracticeLocationAddress": "602 COMMERCE AVE",
"SecondLinePracticeLocationAddress": "SUITE E",
"PracticeLocationAddressCityName": "PALMDALE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93551",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "661-810-3671",
"PracticeLocationAddressFaxNumber": "818-302-2101",
"EnumerationDate": "06/07/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
"AuthorizedOfficialFirstName": "ASHELY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "661-810-3671",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "93672",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}