Provider Demographics
NPI:1568691574
Name:PAULI, FRED HENRY (LMHC, LPC)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:HENRY
Last Name:PAULI
Suffix:
Gender:M
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51153
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32240-1153
Mailing Address - Country:US
Mailing Address - Phone:904-246-2457
Mailing Address - Fax:904-246-2152
Practice Address - Street 1:422 5TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5614
Practice Address - Country:US
Practice Address - Phone:904-246-2457
Practice Address - Fax:904-246-2152
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001249101Y00000X, 101YA0400X, 101YP2500X
FLMH 6641101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 6641OtherLICENSED MENTAL HEALTH COUNSELOR
GALPC001249OtherPROFESSIONAL COUNSELOR