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General NPI Number Information
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NPI Number | 1013089671
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Entity Type | Individual
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Provider Name | SUSAN JILL RAY LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 970 N KALAHEO AVE STE A212
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City | KAILUA
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State | HI
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Zip | 96734-1857
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Country | US
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Telephone | 808-227-6791
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Fax | 808-744-8322
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Provider Business Mailing Address
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Address Line | 442 KALAMA ST
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City | KAILUA
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State | HI
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Zip | 96734-2045
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Country | US
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Telephone | 808-227-6791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT-109
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 109
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License Number State | HI
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