{
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"NameSuffix": null,
"Credential": "M.A., MFT #118457",
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"FirstLineMailingAddress": "1100 WILSHIRE BLVD APT 2102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90017-1950",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-861-9633",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "617 S OLIVE ST STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-861-9633",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/23/2019",
"LastUpdateDate": "07/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "118457",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}