{
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"FirstLineMailingAddress": "973 HUNTERS MEADOW LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33809-6639",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7208 W SAND LAKE RD STE 305",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORLANDO",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-910-7311",
"PracticeLocationAddressFaxNumber": "863-874-4357",
"EnumerationDate": "03/13/2023",
"LastUpdateDate": "03/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ADAMSON",
"AuthorizedOfficialFirstName": "JACQUELINE",
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"AuthorizedOfficialCredential": "LMFT",
"AuthorizedOfficialTelephoneNumber": "904-910-7317",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}