{
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"FirstLineMailingAddress": "1454 WOODPATH DR",
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"MailingAddressCityName": "FLORISSANT",
"MailingAddressStateName": "MO",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1323 SULLIVAN AVE",
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"EnumerationDate": "06/04/2013",
"LastUpdateDate": "06/04/2013",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLASH",
"AuthorizedOfficialFirstName": "DANIEL",
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"AuthorizedOfficialCredential": "PHD, LPC, NCC, ACS",
"AuthorizedOfficialTelephoneNumber": "314-265-7014",
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"Taxonomy": {
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"TaxonomyName": "Counselor",
"LicenseNumber": "2006005129",
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}