Provider Demographics
NPI:1649693243
Name:VANHEULEN, PAUL I (MALLP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:VANHEULEN
Suffix:I
Gender:M
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6469 SNOW APPLE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2455
Mailing Address - Country:US
Mailing Address - Phone:248-390-5174
Mailing Address - Fax:
Practice Address - Street 1:6469 SNOW APPLE DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2455
Practice Address - Country:US
Practice Address - Phone:248-390-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009610103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist