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Individual

RITA KAY SELF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S.

Contact information

Practice address
3010 E STATE BLVD, FORT WAYNE, IN 46805-4700
(260) 471-2300
(260) 471-2778
Mailing address
2301 LYNN AVE, FORT WAYNE, IN 46805-3742
(260) 482-7871
(260) 745-0405

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
NOT YET LICENSED
IN
101YM0800X
Mental Health Counselor

Other

Enumeration date
03/06/2007
Last updated
07/08/2007
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