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General NPI Number Information
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NPI Number | 1699030221
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Entity Type | Individual
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Provider Name | ALICE FAUSOLD PARRISH M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 2789 ORTIZ AVE
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City | FORT MYERS
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State | FL
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Zip | 33905-7806
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Country | US
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Telephone | 239-273-3222
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Fax | 239-275-9058
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Provider Business Mailing Address
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Address Line | 2857 NW 5TH ST
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City | CAPE CORAL
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State | FL
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Zip | 33993-7061
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Country | US
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Telephone | 239-989-2918
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Fax | 239-275-9058
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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