Doctor Name: | DAVID PAUL |
NPI Number: | 1992194849 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | T.L.L.P. |
License Number: | 6301016193 |
Business Practice Address: | 17160 130th Ave Nunica, MI - 494489450 |
Business Phone Number: | 6168474460 |
Business Fax Number: | |
Mailing Address: | 17160 130th Ave, NUNICA |
State: | MI |
Postal Code: | 494489450 |
Phone Number: | 6168474460 |
Fax Number: | 6168474467 |
NPI Enumeration Date: | 01/15/2015 |
NPI Last Update Date: | 01/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 6301016193 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |