Provider Demographics
NPI:1689817504
Name:KANGAS, PAUL LOUIS
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LOUIS
Last Name:KANGAS
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 1:1104 MAIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2972
Mailing Address - Country:US
Mailing Address - Phone:360-695-0115
Mailing Address - Fax:360-695-3436
Practice Address - Street 1:1104 MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2972
Practice Address - Country:US
Practice Address - Phone:360-695-0115
Practice Address - Fax:360-695-3436
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60041660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health