{
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"FirstLineMailingAddress": "4699 N STATE ROAD 7 STE B1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAUDERDALE LAKES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33319-5870",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "4699 N STATE ROAD 7 STE B1",
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"PracticeLocationAddressCityName": "LAUDERDALE LAKES",
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"PracticeLocationAddressTelephoneNumber": "954-459-7173",
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"EnumerationDate": "07/23/2020",
"LastUpdateDate": "07/23/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TENNIE",
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"AuthorizedOfficialCredential": "PHD, LMFT",
"AuthorizedOfficialTelephoneNumber": "954-459-7173",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}