{
"Npi": {
"NPI": "1811085954",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JENNINGS",
"FirstName": "SHANNON",
"MiddleName": "SHEEHAN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "LMHC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SHEEHAN",
"OtherFirstName": "SHANNON",
"OtherMiddleName": "STAR",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 256",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NILES",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49120-0256",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "574-532-3178",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1170 GREENFIELD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NILES",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49120-3926",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "574-532-3178",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/11/2006",
"LastUpdateDate": "12/30/2024",
"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": "6401019668",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "39001654A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}