{
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"FirstLineMailingAddress": "109 S UNION ST STE 208",
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"MailingAddressCityName": "TRAVERSE CITY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49684-2575",
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"FirstLinePracticeLocationAddress": "109 S UNION ST STE 208",
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"PracticeLocationAddressCityName": "TRAVERSE CITY",
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"PracticeLocationAddressTelephoneNumber": "231-632-9209",
"PracticeLocationAddressFaxNumber": "231-275-7268",
"EnumerationDate": "05/13/2011",
"LastUpdateDate": "06/22/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "PAPAZIAN",
"AuthorizedOfficialFirstName": "GERALD",
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"AuthorizedOfficialCredential": "CAADC, LPC",
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"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}