Provider Demographics
NPI:1205118593
Name:PAUL, MARY ELLEN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:PAUL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SONNY LN
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-5915
Mailing Address - Country:US
Mailing Address - Phone:318-992-5677
Mailing Address - Fax:318-992-5677
Practice Address - Street 1:165 SONNY LN
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-5915
Practice Address - Country:US
Practice Address - Phone:318-992-5677
Practice Address - Fax:318-992-5677
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional