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General NPI Number Information
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NPI Number | 1508169632
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Entity Type | Individual
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Provider Name | CARRIE JO REALL CMHC
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Gender | Female
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Dates
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Enumeration Date | 12/11/2010
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 3375 W MAYFLOWER WAY STE A
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City | LEHI
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State | UT
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Zip | 84043
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Country | US
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Telephone | 801-331-6775
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Fax | 801-766-2010
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Provider Business Mailing Address
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Address Line | 3375 W MAYFLOWER WAY STE A
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City | LEHI
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State | UT
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Zip | 84043-3135
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Country | US
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Telephone | 801-331-6775
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Fax | 801-766-2010
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 139247-6004
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License Number State | UT
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