{
"Npi": {
"NPI": "1689546368",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MULBERRY LODGE CSSP, LLC",
"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": "6500 RYE HILL RD E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT SMITH",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72916-8397",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-650-7083",
"MailingAddressFaxNumber": "479-431-5016",
"FirstLinePracticeLocationAddress": "949 N MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MULBERRY",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72947-8538",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-997-8001",
"PracticeLocationAddressFaxNumber": "479-997-1255",
"EnumerationDate": "09/22/2025",
"LastUpdateDate": "09/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRYANT",
"AuthorizedOfficialFirstName": "CLAUDE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "REGIONAL ADMIN / OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "479-650-7083",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}