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General NPI Number Information
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NPI Number | 1629659578
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Entity Type | Organization
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Legal Business Name | PROSPER INTEGRATED HEALTH CARE
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 10750 W MCDOWELL RD STE C305
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City | AVONDALE
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State | AZ
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Zip | 85392-5964
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Country | US
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Telephone | 623-755-5679
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5135
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City | SUN CITY WEST
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State | AZ
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Zip | 85376-5135
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Country | US
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Telephone | 860-690-5309
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MRS. ELONDA WILSON
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Credential |
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Telephone | 860-690-5309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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