Provider Demographics
NPI:1245358076
Name:DOUSI, PAUL JOHN (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:DOUSI
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 117TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2402
Mailing Address - Country:US
Mailing Address - Phone:763-458-0154
Mailing Address - Fax:763-427-5688
Practice Address - Street 1:6300 117TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2402
Practice Address - Country:US
Practice Address - Phone:763-458-0154
Practice Address - Fax:763-427-5688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist