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General NPI Number Information
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NPI Number | 1992223861
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Entity Type | Organization
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Legal Business Name | CALICO MENTAL HEALTH ASSOCIATES LLC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1520 N ALBERTA ST
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City | PORTLAND
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State | OR
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Zip | 97217-3602
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Country | US
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Telephone | 503-914-5229
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Fax | 503-200-1241
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Provider Business Mailing Address
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Address Line | 4207 SE WOODSTOCK BLVD # 230
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City | PORTLAND
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State | OR
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Zip | 97206-6267
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Country | US
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Telephone | 503-914-5229
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Fax | 503-200-1241
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MRS. AMBER MARIE FLORES
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Credential |
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Telephone | 503-914-5229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | OR
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