{
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"EIN": null,
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"FirstName": "MARY",
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"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LMFT",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4740 GREEN RIVER RD STE 117B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92878-9437",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-496-2465",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4740 GREEN RIVER RD STE 117B",
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"PracticeLocationAddressCityName": "CORONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92878-9437",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-523-0569",
"PracticeLocationAddressFaxNumber": "800-507-8563",
"EnumerationDate": "08/24/2009",
"LastUpdateDate": "05/28/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "LMFT88231",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}