{
  "npi": "1083994701",
  "enumeration_type": "NPI-1",
  "basic": {
    "credential": "LCSW",
    "enumeration_date": "2011-08-25",
    "first_name": "WANDA",
    "last_name": "MCCULLOUGH",
    "last_updated": "2011-08-25",
    "middle_name": "GRACE",
    "name_prefix": "Ms.",
    "name_suffix": "--",
    "sex": "F",
    "sole_proprietor": "YES",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "214 GRACE LN",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "FLORA",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "390716005",
      "state": "MS",
      "telephone_number": "601-500-2727"
    },
    {
      "address_1": "332 HIGHWAY 12 W",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "KOSCIUSKO",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "662-289-9770",
      "postal_code": "390903209",
      "state": "MS",
      "telephone_number": "662-289-1800"
    }
  ],
  "taxonomies": [
    {
      "code": "1041C0700X",
      "desc": "Social Worker, Clinical",
      "license": "C1197",
      "primary": true,
      "state": "MS",
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "80",
        "medicare_type": "Licensed Clinical Social Worker"
      }
    ]
  }
}