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General NPI Number Information
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NPI Number | 1619099652
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Entity Type | Individual
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Provider Name | ROBBY RUSSELL TRUE M.H.R., L.A.D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 408 E WILL ROGERS BLVD
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City | CLAREMORE
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State | OK
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Zip | 74017-7455
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Country | US
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Telephone | 918-283-1423
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Fax | 918-283-1429
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Provider Business Mailing Address
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Address Line | 1108 WALNUT ST
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City | CLAREMORE
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State | OK
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Zip | 74017-8308
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Country | US
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Telephone | 918-342-9875
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 559
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License Number State | OK
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