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General NPI Number Information
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NPI Number | 1104295732
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST THERAPY
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 1104 VINE ST SUITE A
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City | PASO ROBLES
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State | CA
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Zip | 93446-5502
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Country | US
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Telephone | 805-591-7234
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Fax | 805-259-4720
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Provider Business Mailing Address
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Address Line | 1104 VINE ST SUITE A
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City | PASO ROBLES
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State | CA
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Zip | 93446-5502
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Country | US
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Telephone | 805-591-7234
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Fax | 805-259-4720
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE BRANCH
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Credential |
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Telephone | 805-423-7207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC50213
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License Number State | CA
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