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General NPI Number Information
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NPI Number | 1770128050
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Entity Type | Organization
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Legal Business Name | AFFINITY MENTAL HEALTH SERVICES PC
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 1108 KINGWOOD DR
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City | AVON
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State | IN
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Zip | 46123-5500
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Country | US
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Telephone | 317-204-1100
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Fax | 317-271-7054
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Provider Business Mailing Address
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Address Line | 2445 DIRECTORS ROW STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-4936
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Country | US
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Telephone | 317-450-4801
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Fax | 317-969-6727
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Authorized Official
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Title or Position | CEO
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Name | HAILEY BRIANN REED
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Credential |
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Telephone | 317-450-4801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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