Provider Demographics
NPI:1568228641
Name:PRICE, PAUL EDWIN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWIN
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 NE 83RD PL APT 4112
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-7107
Mailing Address - Country:US
Mailing Address - Phone:816-868-0604
Mailing Address - Fax:
Practice Address - Street 1:1512 NE 96TH ST STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-7174
Practice Address - Country:US
Practice Address - Phone:816-868-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty