Provider Demographics
NPI:1346313806
Name:HUNNINEN, PAUL (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HUNNINEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COUNTY ROAD 252
Mailing Address - Street 2:
Mailing Address - City:GLEN
Mailing Address - State:MS
Mailing Address - Zip Code:38846-9741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 FOOTE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4834
Practice Address - Country:US
Practice Address - Phone:662-286-4424
Practice Address - Fax:662-287-2070
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC19051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSQ65723Medicare UPIN