Provider Demographics
NPI:1073173308
Name:PAUL, TIONAH (BACHELORS OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:TIONAH
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:BACHELORS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18532 LAKE HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5274
Mailing Address - Country:US
Mailing Address - Phone:225-323-2253
Mailing Address - Fax:
Practice Address - Street 1:10830 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-5014
Practice Address - Country:US
Practice Address - Phone:225-323-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1889989Medicaid