Provider Demographics
NPI:1235629874
Name:PAUL, LONNIE (LPC)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 EASTLAND DR N STE A
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8427
Mailing Address - Country:US
Mailing Address - Phone:208-736-0695
Mailing Address - Fax:208-725-2482
Practice Address - Street 1:1092 EASTLAND DR N STE A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-736-0695
Practice Address - Fax:208-735-2482
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional