{
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"Credential": "LMFT, ATR",
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"FirstLineMailingAddress": "275 BAKER ST STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COSTA MESA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92626-4566",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "213-663-8704",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "275 BAKER ST STE A",
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"PracticeLocationAddressCityName": "COSTA MESA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "213-663-8704",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/22/2007",
"LastUpdateDate": "11/03/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC45167",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}