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General NPI Number Information
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NPI Number | 1326139965
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Entity Type | Individual
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Provider Name | ROBERT R. DAVIDSON M.DIV., M.ED., LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4110 PACIFIC AVE SUITE 202
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City | FOREST GROVE
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State | OR
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Zip | 97116-2266
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Country | US
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Telephone | 503-357-9548
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Fax | 503-357-1158
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Provider Business Mailing Address
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Address Line | 45535 NW LEVI WHITE RD
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City | BANKS
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State | OR
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Zip | 97106-7434
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Country | US
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Telephone | 503-324-4124
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0095
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License Number State | OR
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