{
"Npi": {
"NPI": "1316181365",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CLAYCON LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8829 CENTRE STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHAVEN",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38671",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-280-5758",
"MailingAddressFaxNumber": "662-280-5708",
"FirstLinePracticeLocationAddress": "8829 CENTRE STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHAVEN",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38671",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-280-5758",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/21/2009",
"LastUpdateDate": "06/06/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
"AuthorizedOfficialFirstName": "MERRILLE",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "EXECUTIVE ASSISTANCE",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "662-510-5264",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": "TPR-BADA-APH-01",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": "TPR-BADA-SAPT- 01",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}