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General NPI Number Information
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NPI Number | 1376041319
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Entity Type | Individual
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Provider Name | MICHAEL SANTAMBROGIO MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 20 BENCHMARK ROAD SUITE 224
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City | AVON
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State | CO
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Zip | 81620
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Country | US
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Telephone | 970-376-7913
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 536
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City | EDWARDS
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State | CO
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Zip | 81632-0536
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Country | US
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Telephone | 970-376-7913
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | LPC.0019992
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License Number State | CO
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