{
"Npi": {
"NPI": "1699327411",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WILLEMSE",
"FirstName": "LINDA",
"MiddleName": "KAY",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": "LMFT, RN, PHN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SCHULTZ",
"OtherFirstName": "LINDA",
"OtherMiddleName": "KAY",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "LMFT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "15677 AVENIDA ALCACHOFA #B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92128-4452",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-496-4900",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15677 AVENIDA ALCACHOFA #B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92128-4452",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-496-4900",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/11/2019",
"LastUpdateDate": "10/08/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "50653",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}