{
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"FirstLineMailingAddress": "1790 N LEE TREVINO DR",
"SecondLineMailingAddress": "STE 501",
"MailingAddressCityName": "EL PASO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79936-4545",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "915-849-7917",
"MailingAddressFaxNumber": "915-849-7910",
"FirstLinePracticeLocationAddress": "1790 N LEE TREVINO DR",
"SecondLinePracticeLocationAddress": "STE 501",
"PracticeLocationAddressCityName": "EL PASO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "915-849-7917",
"PracticeLocationAddressFaxNumber": "915-849-7910",
"EnumerationDate": "04/19/2008",
"LastUpdateDate": "02/07/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AVALOS",
"AuthorizedOfficialFirstName": "ADANTE",
"AuthorizedOfficialMiddleName": "RAMON",
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"AuthorizedOfficialCredential": "L.P.C.",
"AuthorizedOfficialTelephoneNumber": "915-849-7917",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "13656",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}