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General NPI Number Information
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NPI Number | 1346976891
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Entity Type | Organization
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Legal Business Name | MICHAEL KIMBALL INTEGRATIVE PSYCHOTHERAPY
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 6635 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43617-1029
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Country | US
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Telephone | 419-517-0105
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Fax | 419-517-1349
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Provider Business Mailing Address
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Address Line | 7040 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-1923
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Country | US
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Telephone | 734-693-0554
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Fax | 419-517-1349
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | MICHAEL KIMBALL
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Credential | PSY.D.
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Telephone | 734-693-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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