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General NPI Number Information
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NPI Number | 1598336604
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Entity Type | Organization
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Legal Business Name | AACE HEALTH NETWORK, LLC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 5776 NW ZINNIA ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-3501
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Country | US
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Telephone | 949-702-0918
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880621
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34988-0621
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Country | US
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Telephone | 772-281-0600
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KARISSA BOLDEN
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Credential | LMHC
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Telephone | 772-210-4586
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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 |
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License Number State |
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