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General NPI Number Information
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NPI Number | 1790548337
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Entity Type | Organization
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Legal Business Name | METAMORPH THERAPY PLLC
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE STE 217
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City | CHICAGO
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State | IL
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Zip | 60625-1032
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Country | US
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Telephone | 773-492-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 1934 N WASHTENAW AVE APT 316
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City | CHICAGO
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State | IL
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Zip | 60647-7137
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Country | US
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Telephone | 773-495-1844
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMANDA CUTTING
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Credential | LCPC, ATR
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Telephone | 773-495-1844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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