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General NPI Number Information
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NPI Number | 1487937066
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Entity Type | Organization
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Legal Business Name | A RENEWED MIND
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 900 W SOUTH BOUNDARY ST BLDG 2
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City | PERRYSBURG
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State | OH
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Zip | 43551-5230
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Country | US
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Telephone | 419-873-8280
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Fax | 419-873-8320
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Provider Business Mailing Address
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Address Line | 1704 CASS RD
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City | MAUMEE
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State | OH
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Zip | 43537-2331
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Country | US
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Telephone | 614-962-0264
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MR. JAMES JEFFREY EARLE
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Credential | MAE, MRC; CDCA; LPC
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Telephone | 419-873-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C.0500399
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License Number State | OH
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