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General NPI Number Information
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NPI Number | 1730088014
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Entity Type | Organization
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Legal Business Name | BLENDED ROOTS LICENSED CLINICAL SOCIAL WORKER INC.,
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 3841 VER HALEN CT
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City | CULVER CITY
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State | CA
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Zip | 90232-3018
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Country | US
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Telephone | 213-464-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 3841 VER HALEN CT
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City | CULVER CITY
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State | CA
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Zip | 90232-3018
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Country | US
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Telephone | 213-464-4404
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER/DIR. OF MENTAL HEALTH
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Name | JARED MORGAN
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Credential | LCSW
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Telephone | 213-464-4404
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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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