{
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"EIN": null,
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"FirstLineMailingAddress": "4401 ATLANTIC AVE STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONG BEACH",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-321-6862",
"MailingAddressFaxNumber": "310-597-4962",
"FirstLinePracticeLocationAddress": "341 HILLCREST ST",
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"PracticeLocationAddressCityName": "LA HABRA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-691-3263",
"PracticeLocationAddressFaxNumber": "562-690-5063",
"EnumerationDate": "11/03/2006",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "39679",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}