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General NPI Number Information
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NPI Number | 1235365487
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Entity Type | Organization
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Legal Business Name | PORTER STARKE SERVICES
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 601 WALL ST
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City | VALPARAISO
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State | IN
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Zip | 46383-2512
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Country | US
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Telephone | 219-531-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 729 COYOTE TRL
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City | KOUTS
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State | IN
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Zip | 46347-9305
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Country | US
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Telephone | 219-743-2815
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MRS. LJUBICA ALLIE
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Credential | MS, LMHC, LCAC
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Telephone | 219-476-4533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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