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General NPI Number Information
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NPI Number | 1023521747
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Entity Type | Organization
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Legal Business Name | FOCAL CLINIC INC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 3305 MAIN ST STE 205
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City | VANCOUVER
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State | WA
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Zip | 98663
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Country | US
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Telephone | 360-282-6650
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Fax | 360-397-7500
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Provider Business Mailing Address
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Address Line | 3305 MAIN STREET SUITE 205
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City | VANCOUVER
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State | WA
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Zip | 98663
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Country | US
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Telephone | 360-282-6650
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Fax | 360-397-7500
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTIONER
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Name | MR. WILLIAM DEHEN
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Credential | ARNP
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Telephone | 360-282-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | AP60095630
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License Number State | WA
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