{
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"EIN": null,
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"OtherOrgNameTypeCode": null,
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"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "5480 BALTIMORE DR",
"SecondLineMailingAddress": "SUITE 250",
"MailingAddressCityName": "LA MESA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91942-2020",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-630-5113",
"MailingAddressFaxNumber": "619-303-3306",
"FirstLinePracticeLocationAddress": "5480 BALTIMORE DR",
"SecondLinePracticeLocationAddress": "SUITE 250",
"PracticeLocationAddressCityName": "LA MESA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-630-5113",
"PracticeLocationAddressFaxNumber": "619-303-3306",
"EnumerationDate": "07/16/2006",
"LastUpdateDate": "06/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "MFC 50604",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}