Provider Demographics
NPI:1629776786
Name:PAULSEN, MONTIE LEE
Entity Type:Individual
Prefix:MRS
First Name:MONTIE
Middle Name:LEE
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 N ALDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1290
Mailing Address - Country:US
Mailing Address - Phone:719-251-1668
Mailing Address - Fax:
Practice Address - Street 1:503 N MAIN ST STE 648
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3174
Practice Address - Country:US
Practice Address - Phone:719-251-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional