{
"Npi": {
"NPI": "1831209816",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHAKER CLINIC, 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": "6000 TOWER CIRCLE",
"SecondLineMailingAddress": "SUITE 1000",
"MailingAddressCityName": "FRANKLIN",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37067",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-861-1000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "20600 CHAGRIN BLVD",
"SecondLinePracticeLocationAddress": "SUITE 620",
"PracticeLocationAddressCityName": "SHAKER HEIGHTS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44122-5327",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-751-4762",
"PracticeLocationAddressFaxNumber": "216-751-5894",
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "09/25/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOWARD",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP & TREASURER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-861-6000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "0519",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}