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General NPI Number Information
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NPI Number | 1619876125
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Entity Type | Individual
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Provider Name | STORMIE LORRAINE BECKERLE LAAC
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Gender | Female
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 1740 E BEVERLY AVE
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City | KINGMAN
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State | AZ
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Zip | 86409-3564
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Country | US
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Telephone | 928-753-9383
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 RAWHIDE DR
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City | KINGMAN
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State | AZ
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Zip | 86401-7820
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Country | US
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Telephone | 928-530-1561
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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 | 15201
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License Number State | AZ
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