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General NPI Number Information
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NPI Number | 1497180921
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Entity Type | Organization
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Legal Business Name | LIFEMEND LLC
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 134 ENCHANTED PKWY
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City | MANCHESTER
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State | MO
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Zip | 63021-5495
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Country | US
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Telephone | 636-686-0597
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Fax | 484-694-3587
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Provider Business Mailing Address
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Address Line | PO BOX 832
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City | BALLWIN
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State | MO
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Zip | 63011-1132
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Country | US
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Telephone | 484-686-0597
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Fax | 484-694-3587
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KAREN S KLINE
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Credential | PHD
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Telephone | 636-686-0597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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