{
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"FirstLineMailingAddress": "PO BOX 1511",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KILLEEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76540-1511",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "254-690-2004",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2201 S W S YOUNG DR",
"SecondLinePracticeLocationAddress": "STE. 105C",
"PracticeLocationAddressCityName": "KILLEEN",
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"PracticeLocationAddressPostalCode": "76543-5317",
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"EnumerationDate": "12/16/2009",
"LastUpdateDate": "12/16/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOMLIN",
"AuthorizedOfficialFirstName": "ALTRAC",
"AuthorizedOfficialMiddleName": "RUTH",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
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"AuthorizedOfficialCredential": "ED.D, LMFT, LPC",
"AuthorizedOfficialTelephoneNumber": "254-690-2004",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "1863",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}