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General NPI Number Information
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NPI Number | 1184429789
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Entity Type | Individual
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Provider Name | DEKAYLA ELLIOTT
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1715 N GRANVILLE AVE STE C
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City | MUNCIE
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State | IN
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Zip | 47303-2149
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Country | US
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Telephone | 765-749-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 405 S CELIA AVE
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City | MUNCIE
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State | IN
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Zip | 47303
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Country | US
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Telephone | 765-713-9429
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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 |
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License Number State |
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