Provider Demographics
NPI:1750590576
Name:DEROULET, PAUL EDWARD (LBSW, LCDC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWARD
Last Name:DEROULET
Suffix:
Gender:M
Credentials:LBSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 MEMORIAL DR APT 38
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4814
Mailing Address - Country:US
Mailing Address - Phone:713-973-8713
Mailing Address - Fax:
Practice Address - Street 1:303 JACKSON HILL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7407
Practice Address - Country:US
Practice Address - Phone:713-942-4100
Practice Address - Fax:713-400-3549
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35018171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator