{
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"EIN": null,
"IsSoleProprietor": "Y",
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"ParentOrgLBN": null,
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"OrgName": null,
"LastName": "SHELL",
"FirstName": "LAVERNE",
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"Credential": "MFT",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3500 PICKWICK CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARMICHAEL",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95608-3457",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-944-8491",
"MailingAddressFaxNumber": "916-972-7746",
"FirstLinePracticeLocationAddress": "4144 WINDING WAY",
"SecondLinePracticeLocationAddress": "SUITE 113",
"PracticeLocationAddressCityName": "CARMICHAEL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-944-8491",
"PracticeLocationAddressFaxNumber": "916-972-7746",
"EnumerationDate": "10/28/2008",
"LastUpdateDate": "10/31/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "27512",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}