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General NPI Number Information
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NPI Number | 1306084124
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Entity Type | Individual
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Provider Name | GAIL P DYNE MFT
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Gender | Female
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 149 N MAIN ST STE 200
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City | LAKEPORT
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State | CA
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Zip | 95453-4846
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Country | US
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Telephone | 707-245-8324
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Fax | 707-279-4690
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Provider Business Mailing Address
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Address Line | 2361 EAST LAKE DR.
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City | KELSEYVILLE
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State | CA
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Zip | 95451
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Country | US
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Telephone | 707-279-4690
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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 | MFC27862
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License Number State | CA
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