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General NPI Number Information
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NPI Number | 1144073198
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Entity Type | Organization
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Legal Business Name | MY THERAPIST KYLIE LLC
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 8465 KEYSTONE CROSSING SUITE 115 #912
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City | INDIANAPOLIS
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State | IN
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Zip | 46240
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Country | US
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Telephone | 260-667-3672
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 455
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City | FREMONT
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State | IN
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Zip | 46737-0455
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Country | US
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Telephone | 260-667-3672
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | KYLIE R LOWRY
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Credential | LMFT
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Telephone | 260-667-3672
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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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