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General NPI Number Information
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NPI Number | 1871291963
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Entity Type | Organization
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Legal Business Name | MED CITY PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 3265 19TH ST NW STE 310
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City | ROCHESTER
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State | MN
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Zip | 55901-6786
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Country | US
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Telephone | 507-990-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 9TH AVE SE
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City | ROCHESTER
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State | MN
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Zip | 55904-5073
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Country | US
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Telephone | 507-990-2396
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATELYN ALESHIRE OLGREN
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Credential | LICSW
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Telephone | 507-990-2396
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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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