{
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"EIN": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": "PSYD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "4413 SHADEWAY RD",
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"MailingAddressCityName": "LAKEWOOD",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-721-7110",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8 CORPORATE PARK STE 300",
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"PracticeLocationAddressCityName": "IRVINE",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-231-7022",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/26/2018",
"LastUpdateDate": "09/26/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "108460",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}