{
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"FirstLineMailingAddress": "4200 HULEN ST.",
"SecondLineMailingAddress": "SUITE 318",
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76109",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-296-6053",
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"FirstLinePracticeLocationAddress": "4200 S HULEN ST",
"SecondLinePracticeLocationAddress": "SUITE 318",
"PracticeLocationAddressCityName": "FORT WORTH",
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"PracticeLocationAddressPostalCode": "76109-4914",
"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/10/2015",
"LastUpdateDate": "04/10/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCLARTY",
"AuthorizedOfficialFirstName": "KELLIE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "LPC, LCDC",
"AuthorizedOfficialNamePrefix": "MRS.",
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"AuthorizedOfficialCredential": "M.ED.",
"AuthorizedOfficialTelephoneNumber": "817-296-6053",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "7917",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"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."
},
{
"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."
}
]
}
}
}