Provider Demographics
NPI:1700343829
Name:ADAMS, PAUL GERARD (LPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GERARD
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 NW EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5826
Mailing Address - Country:US
Mailing Address - Phone:580-678-6631
Mailing Address - Fax:
Practice Address - Street 1:5529 NW EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5826
Practice Address - Country:US
Practice Address - Phone:580-678-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7014OtherOKLAHOMA STATE BOARD OF BEHAVIORAL HEALTH LICENSURE