{
"Npi": {
"NPI": "1801272448",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STARKS",
"FirstName": "JENNIFER",
"MiddleName": "LEE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "19663 MOUNTAIN HOUSE PKWY STE 333",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNTAIN HOUSE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95391-8042",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-222-8802",
"MailingAddressFaxNumber": "209-255-4536",
"FirstLinePracticeLocationAddress": "403 W 11TH ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TRACY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95376-3816",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-222-8802",
"PracticeLocationAddressFaxNumber": "209-255-4536",
"EnumerationDate": "08/05/2015",
"LastUpdateDate": "11/13/2024",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LMFT101980",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "LMFT101980",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}