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General NPI Number Information
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NPI Number | 1700759255
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Entity Type | Organization
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Legal Business Name | FULL SPECTRUM THERAPY
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 805 N ARTHUR AVE
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City | POCATELLO
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State | ID
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Zip | 83204-2803
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Country | US
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Telephone | 208-274-5925
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Fax |
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Provider Business Mailing Address
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Address Line | 5136 HENRY AVE
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City | CHUBBUCK
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State | ID
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Zip | 83202-2207
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Country | US
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Telephone | 307-248-1540
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. SOPHIA RAYE HARMISON
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Credential | MSW
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Telephone | 307-248-1540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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