{
"Npi": {
"NPI": "1437699543",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MANIFESTING EXCELLENCE 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": "6100 CHANNINGWAY BLVD",
"SecondLineMailingAddress": "SUITE 605",
"MailingAddressCityName": "COLUMBUS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43232-2910",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-626-8464",
"MailingAddressFaxNumber": "614-626-8809",
"FirstLinePracticeLocationAddress": "6100 CHANNINGWAY BLVD",
"SecondLinePracticeLocationAddress": "SUITE 605",
"PracticeLocationAddressCityName": "COLUMBUS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43232-2910",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-694-0990",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/08/2017",
"LastUpdateDate": "04/28/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRAWLEY-MCGHEE",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "OWNER/ CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LICDC-CS",
"AuthorizedOfficialTelephoneNumber": "614-626-8464",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": "964511",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "964511",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}