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General NPI Number Information
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NPI Number | 1407311616
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Entity Type | Organization
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Legal Business Name | FULL OF LIFE THERAPY LLC
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 11427 REED HARTMAN HWY
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City | BLUE ASH
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State | OH
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Zip | 45241-2418
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Country | US
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Telephone | 513-268-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 731 HUMOCK CT
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City | MAINEVILLE
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State | OH
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Zip | 45039-7369
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Country | US
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Telephone | 817-729-7563
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Fax |
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Authorized Official
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Title or Position | LISW
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Name | EIESHIA REID-OVERBAUGH
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Credential |
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Telephone | 817-729-7563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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