{
"Npi": {
"NPI": "1760252779",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHANNON-HUTCHISON",
"FirstName": "NAT",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW (IL)/LLMSW (MI)",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5557 28TH ST SE STE B215",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49512-2025",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-259-0186",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1000 MONROE AVE NW",
"SecondLinePracticeLocationAddress": "RIVER CITY PSYCHOLOGICAL SERVICES",
"PracticeLocationAddressCityName": "GRAND RAPIDS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49503-1455",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-259-7207",
"PracticeLocationAddressFaxNumber": "616-259-7261",
"EnumerationDate": "01/02/2024",
"LastUpdateDate": "08/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "LL6851111134",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "149.026007",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}