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General NPI Number Information
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NPI Number | 1427199355
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Entity Type | Individual
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Provider Name | BRYN EVAN MARCUS LMHC
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3900 BROADWAY STE B1
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City | FORT MYERS
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State | FL
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Zip | 33901-8193
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Country | US
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Telephone | 239-939-2808
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Fax | 239-939-4794
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Provider Business Mailing Address
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Address Line | 5221 SW 8TH PL
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City | CAPE CORAL
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State | FL
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Zip | 33914-7012
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Country | US
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Telephone | 941-504-9759
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8583
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License Number State | FL
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