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General NPI Number Information
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NPI Number | 1932685963
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Entity Type | Organization
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Legal Business Name | SOUTHERN OREGON MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 328 S CENTRAL AVE STE 211
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City | MEDFORD
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State | OR
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Zip | 97501-7274
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Country | US
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Telephone | 541-531-6312
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Fax | 888-281-8465
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Provider Business Mailing Address
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Address Line | PO BOX 4322
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City | MEDFORD
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State | OR
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Zip | 97501-0165
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Country | US
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Telephone | 541-531-6312
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Fax | 888-281-8465
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MS. NOEL CHANEY
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Credential | LCSW
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Telephone | 541-531-6312
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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 | L7604
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License Number State | OR
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