Provider Demographics
NPI:1558661389
Name:RASMUSSEN, PAUL RONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RONALD
Last Name:RASMUSSEN
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 1:313 HUNTERS CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-6190
Mailing Address - Country:US
Mailing Address - Phone:864-907-6022
Mailing Address - Fax:
Practice Address - Street 1:107 E PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1631
Practice Address - Country:US
Practice Address - Phone:864-370-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC525103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical