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General NPI Number Information
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NPI Number | 1750672390
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC MEDICAL & PSYCHIATRIC SERVICES LLC.
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Dates
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Enumeration Date | 05/01/2011
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1501 STUBBS AVE
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City | MONROE
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State | LA
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Zip | 71292-1106
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Country | US
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Telephone | 318-396-9712
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Fax | 180-051-8423
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Provider Business Mailing Address
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Address Line | 200 WINTERPARK DR
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City | WEST MONROE
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State | LA
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Zip | 71292-1106
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Country | US
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Telephone | 318-396-9712
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Fax | 180-051-8423
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DIANE PRIVITOR PRIVITOR DAVIS
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Credential | APRN, FNP-C, PMHNPBC
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Telephone | 318-816-5116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APO5002
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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