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Individual
JACK STEVEN DANIELS
Active
Individual
JACK STEVEN DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
129387
TX
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
129387
TX
Other
Enumeration date
05/05/2023
Last updated
05/05/2023
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