{
"Npi": {
"NPI": "1043391980",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TILLEY",
"FirstName": "KELLY",
"MiddleName": "RENEE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MA, LPCC-S, LMHC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CLAPPER",
"OtherFirstName": "KELLY",
"OtherMiddleName": "RENEE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.A., L.P.C.C., LMHC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "39066 SMITH RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LITCHFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44253-9603",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "440-376-1842",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "625 LOOP RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KENT",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44242-9225",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-672-4287",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/18/2006",
"LastUpdateDate": "06/10/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LMHC10004142",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "E.0003996-SUPV",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}