Provider Demographics
NPI:1801966825
Name:ELLINGSEN, PAUL NATHANEAL JR (MFT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:NATHANEAL
Last Name:ELLINGSEN
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 WILLOWSPRING DR S
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4136
Mailing Address - Country:US
Mailing Address - Phone:858-736-4099
Mailing Address - Fax:760-942-9597
Practice Address - Street 1:623 WILLOWSPRING DR S
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4136
Practice Address - Country:US
Practice Address - Phone:858-736-4099
Practice Address - Fax:760-942-9597
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health