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General NPI Number Information
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NPI Number | 1699584896
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Entity Type | Organization
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Legal Business Name | STAND UP PLACER
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 300 DEREK PL
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City | ROSEVILLE
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State | CA
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Zip | 95678-7011
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Country | US
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Telephone | 916-773-7273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5462
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City | AUBURN
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State | CA
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Zip | 95604-5462
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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 | CEO/EXECUTIVE DIRECTOR
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Name | MR. GARY MCDONALD
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Credential |
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Telephone | 530-823-6224
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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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