{
"Npi": {
"NPI": "1902253511",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUTTER COMPASS THERAPY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "2350 CLAYTON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MACON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31204-3045",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-238-0462",
"MailingAddressFaxNumber": "478-257-8247",
"FirstLinePracticeLocationAddress": "2350 CLAYTON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MACON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31204-3045",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-238-0462",
"PracticeLocationAddressFaxNumber": "478-257-8247",
"EnumerationDate": "05/24/2016",
"LastUpdateDate": "05/24/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUTTER",
"AuthorizedOfficialFirstName": "KRISTOPHER",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER, THERAPIST, SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW, LISW-S, MSW",
"AuthorizedOfficialTelephoneNumber": "740-591-1741",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "CSW005790",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}