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General NPI Number Information
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NPI Number | 1447074356
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Entity Type | Organization
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Legal Business Name | OPTIMUM HEALING CIRCLE, LLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2180 W FIRST ST STE 200B
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City | FORT MYERS
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State | FL
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Zip | 33901-3217
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Country | US
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Telephone | 239-387-5008
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Fax | 239-387-5938
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Provider Business Mailing Address
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Address Line | 3026 ROYAL PALM AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-7335
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Country | US
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Telephone | 239-287-5008
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Fax | 239-387-5938
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Authorized Official
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Title or Position | MANAGER
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Name | SHANTEL CHAPMAN
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Credential | LMHC
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Telephone | 239-387-5008
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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 |
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License Number State |
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