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General NPI Number Information
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NPI Number | 1235901679
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Entity Type | Organization
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Legal Business Name | DAVENPORT MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 615 N 1ST AVE
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City | STAYTON
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State | OR
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Zip | 97383-1704
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Country | US
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Telephone | 503-877-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 910 N 8TH ST
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City | AUMSVILLE
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State | OR
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Zip | 97325-8917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHERINE DAVENPORT
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Credential | PSYD
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Telephone | 503-877-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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