Provider Demographics
NPI:1184410276
Name:ALLISON, PAUL MICHAEL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:ALLISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 BOILERMAKER CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-8412
Mailing Address - Country:US
Mailing Address - Phone:219-286-7043
Mailing Address - Fax:
Practice Address - Street 1:2803 BOILERMAKER CT
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8412
Practice Address - Country:US
Practice Address - Phone:219-286-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000140A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health