{
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"EIN": null,
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"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "M.DIV., LCMFT",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10017 W 60TH TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERRIAM",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66203-3129",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "913-609-1345",
"MailingAddressFaxNumber": "913-273-1963",
"FirstLinePracticeLocationAddress": "14895 ANTIOCH RD",
"SecondLinePracticeLocationAddress": "SUITE 131",
"PracticeLocationAddressCityName": "OVERLAND PARK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "913-681-8180",
"PracticeLocationAddressFaxNumber": "913-681-8186",
"EnumerationDate": "02/09/2012",
"LastUpdateDate": "02/09/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "784",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}