{
"Npi": {
"NPI": "1578910808",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EDEN COUNSELING CENTERS LLC MENTAL HEALTH",
"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": "8794 BIG BEAR AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POWELL",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43065-9113",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-398-3470",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8794 BIG BEAR AVENUE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POWELL",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43065-9113",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-398-3470",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/17/2016",
"LastUpdateDate": "05/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JENNINGS",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "EARL",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "614-398-3470",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084B0040X",
"TaxonomyName": "Behavioral Neurology & Neuropsychiatry Physician",
"LicenseNumber": "34010652",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}