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General NPI Number Information
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NPI Number | 1689363368
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Entity Type | Organization
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Legal Business Name | SKYTHERAPIST MANAGEMENT SERVICES ORGANIZATION LLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 3730 KIRBY DR STE 1200
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City | HOUSTON
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State | TX
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Zip | 77098-3985
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Country | US
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Telephone | 404-579-9167
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 S COBB DR SE UNIT 503
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City | SMYRNA
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State | GA
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Zip | 30080-6990
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Country | US
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Telephone | 404-579-9167
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Fax | 404-759-2947
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Authorized Official
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Title or Position | PRINCIPLE
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Name | MR. KEITH JONES
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Credential |
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Telephone | 404-579-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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