{
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"FirstLineMailingAddress": "PO BOX 3392",
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"MailingAddressCityName": "MONUMENT",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "719-333-9210",
"FirstLinePracticeLocationAddress": "1465 KELLY JOHNSON BLVD",
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"PracticeLocationAddressCityName": "COLORADO SPRINGS",
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"PracticeLocationAddressFaxNumber": "719-313-9210",
"EnumerationDate": "06/16/2016",
"LastUpdateDate": "06/16/2016",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRGICH",
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"AuthorizedOfficialCredential": "PST.D.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychologist",
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"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."
}
}
}
}