{
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"FirstLineMailingAddress": "13071 FAIRWAY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHOCTAW",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73020-8147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-245-9233",
"MailingAddressFaxNumber": "405-632-2803",
"FirstLinePracticeLocationAddress": "6922 S WESTERN AVE",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "OKLAHOMA CITY",
"PracticeLocationAddressStateName": "OK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "405-245-9233",
"PracticeLocationAddressFaxNumber": "405-632-2803",
"EnumerationDate": "05/04/2011",
"LastUpdateDate": "05/04/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VERNON",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.A., LBP",
"AuthorizedOfficialTelephoneNumber": "405-245-9233",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "89",
"LicenseNumberStateCode": "OK",
"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."
}
}
}
}