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General NPI Number Information
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NPI Number | 1326477001
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 1455 E PASS RD B
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City | GULFPORT
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State | MS
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Zip | 39507-3523
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Country | US
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Telephone | 228-563-3879
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Fax | 228-864-6979
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Provider Business Mailing Address
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Address Line | 1455 E PASS RD B
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City | GULFPORT
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State | MS
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Zip | 39507-3523
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Country | US
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Telephone | 228-563-3879
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Fax | 228-864-6979
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ESTELLE LACOSTE ROBINSON
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Credential | PH.D., L.P.C.
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Telephone | 228-563-3879
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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 | 1715
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License Number State | MS
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