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General NPI Number Information
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NPI Number | 1366687527
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Entity Type | Organization
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Legal Business Name | NORTHWEST CMHC, L.L.C.
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 2121 FAIRFIELD AVE SUITE 210/220
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City | SHREVEPORT
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State | LA
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Zip | 71104-2057
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Country | US
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Telephone | 225-892-6119
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Fax |
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Provider Business Mailing Address
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Address Line | 1813 ROSALE DR
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City | BATON ROUGE
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State | LA
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Zip | 70806-8566
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Country | US
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Telephone | 225-892-6119
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. DAVID HARRIS
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Credential |
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Telephone | 225-892-6119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | NA
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License Number State |
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