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General NPI Number Information
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NPI Number | 1174027130
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Entity Type | Organization
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Legal Business Name | GOOLSBYS CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 2720 PARK ST STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7645
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Country | US
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Telephone | 904-338-2998
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Fax | 844-250-8734
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Provider Business Mailing Address
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Address Line | 9233 REDTAIL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32222-2811
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Country | US
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Telephone | 904-338-2998
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Fax | 844-250-8734
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN GOOLSBY
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Credential |
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Telephone | 904-338-2998
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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 | MH12309
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License Number State | FL
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