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General NPI Number Information
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NPI Number | 1417548736
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Entity Type | Organization
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Legal Business Name | BOUNCE BACK THERAPY, LLC
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 11351 PIONEER RD SE
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City | LYONS
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State | OR
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Zip | 97358-9759
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Country | US
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Telephone | 503-400-4485
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Fax |
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Provider Business Mailing Address
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Address Line | 11351 PIONEER RD SE
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City | LYONS
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State | OR
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Zip | 97358-9759
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Country | US
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Telephone | 503-400-4485
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Fax |
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Authorized Official
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Title or Position | MA
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Name | CYNTHIA SUE SCOTT
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Credential | LLC REGISTERED
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Telephone | 503-400-4485
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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 |
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License Number State |
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