Provider Demographics
NPI:1639322209
Name:HARLEY, PAULA KAYE (LBSW-IPR)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAYE
Last Name:HARLEY
Suffix:
Gender:F
Credentials:LBSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 FOXHALL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76458-2513
Mailing Address - Country:US
Mailing Address - Phone:940-224-4783
Mailing Address - Fax:940-567-5148
Practice Address - Street 1:902 E HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367-2143
Practice Address - Country:US
Practice Address - Phone:940-781-5745
Practice Address - Fax:940-592-0153
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24089171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator