{
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"OrgName": "CENTRAL FLORIDA MENTAL HEALTH",
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"FirstLineMailingAddress": "221 N HIGHWAY 27",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "CLERMONT",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34711-2431",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-536-2364",
"MailingAddressFaxNumber": "352-536-2370",
"FirstLinePracticeLocationAddress": "221 N HIGHWAY 27",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-536-2364",
"PracticeLocationAddressFaxNumber": "352-536-2370",
"EnumerationDate": "03/13/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLEY",
"AuthorizedOfficialFirstName": "TORI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER COUNSELOR",
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"AuthorizedOfficialCredential": "PHD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "MH7472",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}