{
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"FirstLineMailingAddress": "3800 S W S YOUNG DR STE 104A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KILLEEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76542-3312",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "254-338-3737",
"MailingAddressFaxNumber": "254-519-1151",
"FirstLinePracticeLocationAddress": "3800 S W S YOUNG DR STE 104A",
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"PracticeLocationAddressCityName": "KILLEEN",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "254-519-1150",
"PracticeLocationAddressFaxNumber": "254-519-1151",
"EnumerationDate": "08/19/2015",
"LastUpdateDate": "11/27/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARK-LADD",
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"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "LMFT, LPC",
"AuthorizedOfficialTelephoneNumber": "254-519-1150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "64044",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}