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General NPI Number Information
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NPI Number | 1063652527
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Entity Type | Organization
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Legal Business Name | DECLARE THERAPY CENTER INC
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 700 W PETE ROSE WAY
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City | CINCINNATI
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State | OH
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Zip | 45203-1892
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Country | US
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Telephone | 513-290-7908
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Fax | 513-834-7052
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Provider Business Mailing Address
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Address Line | 700 W PETE ROSE WAY STE 456
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City | CINCINNATI
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State | OH
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Zip | 45203-1875
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Country | US
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Telephone | 513-834-7050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. PURCELL TAYLOR JR.
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Credential | ED.D.
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Telephone | 513-290-7908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 85387
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | E0000656, 85387
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License Number State | OH
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