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General NPI Number Information
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NPI Number | 1467801969
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Entity Type | Organization
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Legal Business Name | JOY WEAKS, LCPC
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 307 1ST AVE E SUITE 11
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City | KALISPELL
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State | MT
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Zip | 59901-4978
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Country | US
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Telephone | 406-544-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 307 1ST AVE E SUITE 11
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City | KALISPELL
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State | MT
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Zip | 59901-4978
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Country | US
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Telephone | 406-544-5517
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PROF. COUNSELOR
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Name | MRS. JOY LORRAINE WEAKS
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Credential | M.A., LCPC
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Telephone | 406-544-5517
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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 | BBH-LCPC-LIC-7654
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License Number State | MT
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