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General NPI Number Information
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NPI Number | 1699945360
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Entity Type | Organization
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Legal Business Name | SUMMIT MENTAL HEALTH CLINIC PA
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 4131 SPICEWOOD SPRINGS RD BLDG#L, #2
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City | AUSTIN
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State | TX
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Zip | 78759-8661
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Country | US
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Telephone | 512-732-2122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17906
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City | AUSTIN
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State | TX
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Zip | 78760-7906
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Country | US
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Telephone | 512-732-2122
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | DR. FRANCISCA ADA IFESINACHUKWU
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Credential | M.D.
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Telephone | 512-732-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | L1620
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License Number State | TX
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