Provider Demographics
NPI:1710138318
Name:ARAGON, PAUL C (CADC II)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:ARAGON
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NE MANZANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1400
Mailing Address - Country:US
Mailing Address - Phone:541-479-8847
Mailing Address - Fax:541-471-2679
Practice Address - Street 1:109 NE MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1400
Practice Address - Country:US
Practice Address - Phone:541-479-8847
Practice Address - Fax:541-471-2679
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103K00000X
OR11-R-26101YA0400X
OR19-P-13101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500733844Medicaid