Provider Demographics
NPI:1134656820
Name:PAUL, JOHN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:UNIVERSITY OF WISCONSIN-SUPERIOR, SWENSON 2060
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4500
Mailing Address - Country:US
Mailing Address - Phone:715-394-8151
Mailing Address - Fax:
Practice Address - Street 1:1500 N 34TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4476
Practice Address - Country:US
Practice Address - Phone:218-464-3057
Practice Address - Fax:888-724-4599
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health