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General NPI Number Information
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NPI Number | 1265058788
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Entity Type | Individual
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Provider Name | STEPHENIE JO WOLFORD-WARD LMT, LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/20/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 633 UMATILLA BLVD
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City | UMATILLA
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State | FL
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Zip | 32784-8418
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Country | US
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Telephone | 352-669-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 113 E BLUE WATER EDGE DR
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City | EUSTIS
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State | FL
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Zip | 32736-2250
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Country | US
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Telephone | 407-949-7489
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA48563
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH15532
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License Number State | FL
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