Provider Demographics
NPI:1255932331
Name:PAULL, KENNETH A (LCSWA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:PAULL
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48549 GAMMON CT APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1804
Mailing Address - Country:US
Mailing Address - Phone:520-437-1010
Mailing Address - Fax:
Practice Address - Street 1:UNIT 33100 BOX BAUMHOLDER
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-3100
Practice Address - Country:US
Practice Address - Phone:314-590-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0159751041C0700X
NCC0159871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical