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General NPI Number Information
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NPI Number | 1467242503
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Entity Type | Individual
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Provider Name | CALEB ANDREW COHEN
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Gender | Male
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 350 SOUTHBRIDGE ST
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City | MOORESVILLE
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State | IN
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Zip | 46158-2794
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Country | US
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Telephone | 206-414-9022
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Fax |
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Provider Business Mailing Address
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Address Line | 331 S GRANT ST APT 3
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7603
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Country | US
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Telephone | 317-438-7966
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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 |
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License Number State |
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