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General NPI Number Information
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NPI Number | 1336682467
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Entity Type | Organization
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Legal Business Name | MICHAEL R JONES THERAPY
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 532 DON GASPAR AVE
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City | SANTA FE
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State | NM
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Zip | 87505-2626
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Country | US
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Telephone | 505-985-5644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 32145
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City | SANTA FE
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State | NM
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Zip | 87594-2145
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Country | US
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Telephone | 505-985-5644
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MICHAEL RUTHERFORD JONES
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Credential | PH.D., L.C.S.W.
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Telephone | 505-985-5644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-09546
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License Number State | NM
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