{
"Npi": {
"NPI": "1275899056",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AUTHENTIC THERAPIES",
"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": "1898 FISK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOWELL",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48843-8823",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-294-9237",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "144 SCHROEDER PARK DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOWELL",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48843-8990",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "517-294-9237",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/06/2012",
"LastUpdateDate": "04/06/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STRATTON",
"AuthorizedOfficialFirstName": "RUSSELL",
"AuthorizedOfficialMiddleName": "ALLEN",
"AuthorizedOfficialTitle": "THERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMSW",
"AuthorizedOfficialTelephoneNumber": "517-294-9237",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "6801087882",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}