Provider Demographics
NPI:1295356046
Name:APPLEBY, PAUL (LISAC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:APPLEBY
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4427
Mailing Address - Country:US
Mailing Address - Phone:623-326-1055
Mailing Address - Fax:
Practice Address - Street 1:500 N FLORENCE ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4427
Practice Address - Country:US
Practice Address - Phone:623-326-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSA1232101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)