Provider Demographics
NPI:1467669879
Name:ADAMS, PAUL W (EDD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:ADAMS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90096 476TH AVE
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NE
Mailing Address - Zip Code:68713-4435
Mailing Address - Country:US
Mailing Address - Phone:402-775-2187
Mailing Address - Fax:
Practice Address - Street 1:90096 476TH AVE
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NE
Practice Address - Zip Code:68713-4435
Practice Address - Country:US
Practice Address - Phone:402-775-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE347103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE276337Medicare ID - Type Unspecified