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General NPI Number Information
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NPI Number | 1174874911
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Entity Type | Individual
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Provider Name | JAMES R MAXWELL MA, LMFT, LMHC
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Gender | Male
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 400 E EVERGREEN BLVD SUITE 301C
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City | VANCOUVER
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State | WA
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Zip | 98660-3331
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Country | US
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Telephone | 360-635-1422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2606
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City | VANCOUVER
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State | WA
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Zip | 98668-2606
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Country | US
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Telephone | 360-635-1422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LH 60160545
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF 60160510
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License Number State | WA
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