{
"Npi": {
"NPI": "1609220326",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NORTHRUP",
"FirstName": "SHELLEY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPC, ED.S, MH.S",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11138 STATE BRIDGE ROAD",
"SecondLineMailingAddress": "SUITE 100A",
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30337-3605",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-274-4936",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11138 STATE BRIDGE RD STE 100A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALPHARETTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30022-7465",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-274-4936",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/19/2016",
"LastUpdateDate": "02/21/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "APC005359",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "LPC010477",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}