Provider Demographics
NPI:1396072286
Name:PAUL, VANESSA IRENE (LMFT)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:IRENE
Last Name:PAUL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E CLARK AVE # A
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5262
Mailing Address - Country:US
Mailing Address - Phone:805-863-9067
Mailing Address - Fax:
Practice Address - Street 1:535 E CLARK AVE # A
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-5262
Practice Address - Country:US
Practice Address - Phone:805-863-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA87229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor