{
  "npi": "1629432182",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "ANGELA",
    "authorized_official_last_name": "SUPPLEE",
    "authorized_official_telephone_number": "4174761013",
    "authorized_official_title_or_position": "Payer Enrollment Manager",
    "certification_date": "2026-07-23",
    "enumeration_date": "2016-04-11",
    "last_updated": "2026-07-23",
    "organization_name": "CLARK COMMUNITY MENTAL HEALTH CENTER",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 100",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "PIERCE CITY",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "417-476-1082",
      "postal_code": "657232100",
      "state": "MO",
      "telephone_number": "417-476-1000"
    },
    {
      "address_1": "1701 N CENTRAL AVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "MONETT",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "417-476-1082",
      "postal_code": "65708",
      "state": "MO",
      "telephone_number": "417-235-6610"
    }
  ],
  "taxonomies": [
    {
      "code": "251S00000X",
      "desc": "Community/Behavioral Health",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QR0405X",
      "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
      "license": null,
      "primary": false,
      "state": "MO",
      "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 Community/Behavioral Health",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": []
  }
}