Provider Demographics
NPI:1972519304
Name:TIEMAN, PAUL A (DMIN)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:TIEMAN
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CRAWFORD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4972
Mailing Address - Country:US
Mailing Address - Phone:847-332-2783
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE STE 310
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4972
Practice Address - Country:US
Practice Address - Phone:847-332-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health