Provider Demographics
NPI:1760582324
Name:OUSMAN, PAUL BRADLEY (LP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRADLEY
Last Name:OUSMAN
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 W 78TH ST
Mailing Address - Street 2:SUITE 285A
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-8715
Mailing Address - Country:US
Mailing Address - Phone:952-412-6304
Mailing Address - Fax:952-974-8468
Practice Address - Street 1:80 W 78TH ST
Practice Address - Street 2:SUITE 285A
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-8715
Practice Address - Country:US
Practice Address - Phone:952-412-6304
Practice Address - Fax:952-974-8468
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3851103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling