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General NPI Number Information
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NPI Number | 1073390589
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Entity Type | Organization
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Legal Business Name | DESERT MAGNOLIA THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 16165 N 83RD AVE 200
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City | PEORIA
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State | AZ
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Zip | 85382-4227
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Country | US
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Telephone | 602-284-4421
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Fax |
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Provider Business Mailing Address
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Address Line | 16165 N 83RD AVE STE 200
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City | PEORIA
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State | AZ
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Zip | 85382-5816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVETTE MEI
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Credential | LCSW
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Telephone | 602-284-4421
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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