Provider Demographics
NPI:1336741776
Name:HORNBOGEN, PAUL JOSEPH (LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:HORNBOGEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:JOSEPH
Other - Last Name:HORNBOGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:701 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2042
Mailing Address - Country:US
Mailing Address - Phone:231-429-6955
Mailing Address - Fax:
Practice Address - Street 1:701 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2042
Practice Address - Country:US
Practice Address - Phone:231-429-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401005749OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS