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General NPI Number Information
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NPI Number | 1841836285
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Entity Type | Organization
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Legal Business Name | CHANGEPOINT INTEGRATED HEALTH
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 1920 WEST COMMERCE DR
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City | LAKESIDE
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State | AZ
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Zip | 85929
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Country | US
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Telephone | 928-368-4110
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Fax | 928-892-5828
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Provider Business Mailing Address
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Address Line | 1801 W DEUCE OF CLUBS STE 100
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City | SHOW LOW
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State | AZ
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Zip | 85901-2704
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Country | US
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Telephone | 928-537-2951
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Fax | 928-892-5828
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Authorized Official
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Title or Position | BILLING / CREDENTIALING
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Name | MICHELE HOSPODKA
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Credential |
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Telephone | 928-537-2951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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