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General NPI Number Information
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NPI Number | 1417328808
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Entity Type | Organization
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Legal Business Name | CENTER FOR COLLABORATIVE HEALTH PLLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 7300 METRO BLVD SUITE 400
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City | EDINA
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State | MN
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Zip | 55439-2468
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Country | US
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Telephone | 612-425-0090
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Fax | 612-425-1580
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Provider Business Mailing Address
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Address Line | 7300 METRO BLVD SUITE 400
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City | EDINA
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State | MN
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Zip | 55439-2468
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Country | US
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Telephone | 612-425-0090
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Fax | 612-425-1580
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NICOLE J SLAVIK
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Credential | PSYD, LP
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Telephone | 612-425-0092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MN5609
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MN5396
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License Number State | MN
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