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General NPI Number Information
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NPI Number | 1376730150
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Entity Type | Organization
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Legal Business Name | ADMHS
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 429 N SAN ANTONIO RD
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City | SANTA BARBARA
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State | CA
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Zip | 93110
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Country | US
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Telephone | 805-884-1629
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Fax |
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Provider Business Mailing Address
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Address Line | 315 CAMINO DEL REMEDIO
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City | SANTA BARBARA
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State | CA
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Zip | 93110-1332
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Country | US
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Telephone | 805-884-1628
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. LENNIE KWOCK
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Credential | LCSW
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Telephone | 805-884-1629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | N4473383
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License Number State | CA
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