Provider Demographics
NPI:1831135359
Name:EHRMANTRAUT, PAULA LYNN (MS MED LCPC CSP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LYNN
Last Name:EHRMANTRAUT
Suffix:
Gender:F
Credentials:MS MED LCPC CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 AMERICAS WAY PMB 2333
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719
Mailing Address - Country:US
Mailing Address - Phone:406-853-6020
Mailing Address - Fax:
Practice Address - Street 1:514 AMERICAS WAY PMB 2333
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:SD
Practice Address - Zip Code:57719
Practice Address - Country:US
Practice Address - Phone:406-853-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1196 LCPC101YM0800X, 101YM0800X
UT12837443-6004101YP2500X
SDLPC-MH30682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256906Medicaid