Provider Demographics
NPI:1710626908
Name:PAUL, ANDREW (LMHCA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52625 NE PORTER LN
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3557
Mailing Address - Country:US
Mailing Address - Phone:503-875-6888
Mailing Address - Fax:
Practice Address - Street 1:52625 NE PORTER LN
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3557
Practice Address - Country:US
Practice Address - Phone:503-875-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61263011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional