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General NPI Number Information
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NPI Number | 1043859614
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Entity Type | Organization
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Legal Business Name | AUDREY MITCHELL, LLC
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 4070 LAKE DRIVE SE SUITE 101
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4954
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Country | US
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Telephone | 616-426-9869
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Fax |
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Provider Business Mailing Address
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Address Line | 547 92ND ST SE
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City | BYRON CENTER
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State | MI
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Zip | 49315
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Country | US
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Telephone | 616-426-9869
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUDREY M MITCHELL
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Credential | LMSW
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Telephone | 616-426-9869
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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 |
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License Number State |
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