{
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"NamePrefix": null,
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"FirstLineMailingAddress": "1111 HAZEL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEXARKANA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75501-5229",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-791-8388",
"MailingAddressFaxNumber": "903-791-8385",
"FirstLinePracticeLocationAddress": "1000 PINE ST",
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"PracticeLocationAddressTelephoneNumber": "903-793-4673",
"PracticeLocationAddressFaxNumber": "903-791-8385",
"EnumerationDate": "06/24/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEPHENS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "903-748-9421",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatric Hospital",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}