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General NPI Number Information
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NPI Number | 1194128942
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Entity Type | Individual
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Provider Name | EUNICE D THOMAS MLC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 15001 HAWKS SHADOW DR
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City | FORT MYERS
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State | FL
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Zip | 33905-2444
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Country | US
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Telephone | 941-276-6614
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Fax | 239-693-0285
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Provider Business Mailing Address
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Address Line | 15001 HAWKS SHADOW DR
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City | FORT MYERS
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State | FL
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Zip | 33905-2444
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Country | US
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Telephone | 941-276-6614
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Fax | 239-693-0285
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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 | IMH5930
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License Number State | FL
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