{
"Npi": {
"NPI": "1184088262",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CLEARWATER COUNSELING CENTER LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3030 HOMESTEAD CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLEARWATER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33759-1619",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "25400 US HIGHWAY 19 N",
"SecondLinePracticeLocationAddress": "SUITE 172",
"PracticeLocationAddressCityName": "CLEARWATER",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33763-2149",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-797-7211",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2016",
"LastUpdateDate": "04/05/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LANE",
"AuthorizedOfficialFirstName": "MARY ANN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SOLE MBR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BCD, LCSW",
"AuthorizedOfficialTelephoneNumber": "727-417-4491",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "SW 3074",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}