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NPI 1689131591

NPI 1689131591 : DONALD M. HOLLIDAY LMSW : JUNCTION CITY, KS

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General NPI Number Information
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    NPI Number           |    1689131591
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    Entity Type          |    Individual 
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    Provider Name        |    DONALD M. HOLLIDAY LMSW
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    02/27/2019
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    Last Update Date     |    02/27/2019
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Provider Practice Location Address
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    Address Line         |    128 PARKVIEW DR 
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    City                 |    JUNCTION CITY
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    State                |    KS
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    Zip                  |    66441-3246
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    Country              |    US
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    Telephone            |    785-209-9135
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    128 PARKVIEW DR 
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    City                 |    JUNCTION CITY
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    State                |    KS
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    Zip                  |    66441-3246
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    Country              |    US
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    Telephone            |    
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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        |    104100000X
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    Taxonomy Name        |    Social Worker
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    License Number       |    11210
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    License Number State |    KS
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