Provider Demographics
NPI:1477010460
Name:VANDAELE, PAUL (MA; LPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:VANDAELE
Suffix:
Gender:M
Credentials:MA; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 N COLUMBINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5257
Mailing Address - Country:US
Mailing Address - Phone:720-212-7446
Mailing Address - Fax:208-485-8911
Practice Address - Street 1:3350 W AMERICANA TER STE 210B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2521
Practice Address - Country:US
Practice Address - Phone:720-212-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional