Provider Demographics
NPI:1972197218
Name:OBDAN, PARIS B (NLC)
Entity Type:Individual
Prefix:MR
First Name:PARIS
Middle Name:B
Last Name:OBDAN
Suffix:
Gender:M
Credentials:NLC
Other - Prefix:MR
Other - First Name:PARIS
Other - Middle Name:
Other - Last Name:OBDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NLC
Mailing Address - Street 1:911 16TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7331
Mailing Address - Country:US
Mailing Address - Phone:919-717-6504
Mailing Address - Fax:
Practice Address - Street 1:911 16TH ST APT 3
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7331
Practice Address - Country:US
Practice Address - Phone:919-717-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0111174102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty