Provider Demographics
NPI:1750310132
Name:SEALE, PAUL M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:SEALE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-8413
Mailing Address - Country:US
Mailing Address - Phone:318-632-2010
Mailing Address - Fax:318-632-2055
Practice Address - Street 1:6240 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-8413
Practice Address - Country:US
Practice Address - Phone:318-632-2010
Practice Address - Fax:318-632-2055
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker