Provider Demographics
NPI:1437186913
Name:PAUL, BRIAN DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:PAUL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W GREGORY BLVD STE 323
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1127
Mailing Address - Country:US
Mailing Address - Phone:816-492-5288
Mailing Address - Fax:844-875-0741
Practice Address - Street 1:222 W GREGORY BLVD STE 323
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1127
Practice Address - Country:US
Practice Address - Phone:816-492-5288
Practice Address - Fax:844-875-0741
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1359103TC1900X
MO2003023863103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000C940Medicare ID - Type Unspecified