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General NPI Number Information
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NPI Number | 1952627374
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Entity Type | Individual
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Provider Name | CONNIE S MASTERS LMFT, LCAC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 715 EDGEWOOD DR
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City | MULVANE
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State | KS
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Zip | 67110-1319
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Country | US
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Telephone | 316-777-4246
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Fax | 316-260-2049
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Provider Business Mailing Address
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Address Line | 715 EDGEWOOD DR
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City | MULVANE
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State | KS
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Zip | 67110-1319
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Country | US
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Telephone | 316-777-4246
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Fax | 316-260-2049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 1014
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License Number State | KS
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