Provider Demographics
NPI:1114660933
Name:PAUL, CODY CYLE (CDCA)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:CYLE
Last Name:PAUL
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 YONDOTA ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2260
Mailing Address - Country:US
Mailing Address - Phone:419-297-0835
Mailing Address - Fax:
Practice Address - Street 1:1760 MANLEY RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9400
Practice Address - Country:US
Practice Address - Phone:419-297-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional