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General NPI Number Information
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NPI Number | 1376011023
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Entity Type | Individual
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Provider Name | AMY I HALE LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 3191 HARBOR BLVD STE A
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6755
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Country | US
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Telephone | 239-223-2751
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Fax |
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Provider Business Mailing Address
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Address Line | 123 N OAKLAND AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-2831
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Country | US
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Telephone | 920-770-4088
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Fax | 651-705-0026
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4214-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH18139
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License Number State | FL
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