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General NPI Number Information
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NPI Number | 1043737570
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Entity Type | Organization
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Legal Business Name | HEALING HOOVES PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 6201 SW 180TH TER
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33331-1611
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Country | US
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Telephone | 954-907-6862
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Fax | 954-907-6862
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Provider Business Mailing Address
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Address Line | 3901 SHADY RIDGE RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6205
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Country | US
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Telephone | 954-907-6862
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SARAH LYNN CHAMBERLIN
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Credential | LMFT
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Telephone | 954-907-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MT3092
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | MT3092
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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