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General NPI Number Information
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NPI Number | 1508900390
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Entity Type | Individual
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Provider Name | JANICE LYNN RAE LPC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24420 FM1314 STE 11
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City | PORTER
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State | TX
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Zip | 77365-5606
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Country | US
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Telephone | 281-354-6144
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Fax | 281-354-6144
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Provider Business Mailing Address
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Address Line | PO BOX 791
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City | PORTER
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State | TX
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Zip | 77365-0791
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Country | US
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Telephone | 281-354-6144
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Fax | 281-354-6144
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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 | LPC-16500
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License Number State | TX
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