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General NPI Number Information
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NPI Number | 1992218119
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Entity Type | Organization
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Legal Business Name | DESERT FAITH THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 10000 N 31ST AVE STE D311
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City | PHOENIX
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State | AZ
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Zip | 85051-1701
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Country | US
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Telephone | 602-573-8689
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Fax |
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Provider Business Mailing Address
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Address Line | 12741 W PERSHING ST
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City | EL MIRAGE
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State | AZ
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Zip | 85335-8225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. STEPHANIE HENRY
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Credential | LCSW
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Telephone | 602-573-8689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | AZ
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