{
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"FirstLineMailingAddress": "470 PLEASANT GROVE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "INVERNESS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34452-5746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-341-0435",
"MailingAddressFaxNumber": "352-341-1562",
"FirstLinePracticeLocationAddress": "470 PLEASANT GROVE RD",
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"PracticeLocationAddressCityName": "INVERNESS",
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"PracticeLocationAddressTelephoneNumber": "352-341-0435",
"PracticeLocationAddressFaxNumber": "352-341-1562",
"EnumerationDate": "05/27/2014",
"LastUpdateDate": "05/28/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FORD PURDY",
"AuthorizedOfficialFirstName": "CYNDIE",
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"AuthorizedOfficialTitle": "CLINICIAN/SOLE PROPRIETOR",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMHC, NCC, MAC, SAP",
"AuthorizedOfficialTelephoneNumber": "352-341-0435",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "MH5401",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}