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NPI 1255841417

NPI 1255841417 : STEVEN PHILLIP ING MFT : RENO, NV

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General NPI Number Information
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    NPI Number           |    1255841417
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    Entity Type          |    Individual 
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    Provider Name        |    STEVEN PHILLIP ING MFT
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    10/02/2017
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    Last Update Date     |    10/02/2017
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Provider Practice Location Address
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    Address Line         |    3500 LAKESIDE CT STE 130 
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    City                 |    RENO
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    State                |    NV
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    Zip                  |    89509-4865
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    Country              |    US
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    Telephone            |    775-329-6002
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3500 LAKESIDE CT STE 130 
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    City                 |    RENO
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    State                |    NV
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    Zip                  |    89509-4865
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    Country              |    US
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    Telephone            |    775-329-6002
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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       |    0554
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    License Number State |    NV
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