Provider Demographics
NPI:1912076415
Name:KROEKEL, PAUL RICHARD (LMFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:KROEKEL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25127
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0102
Mailing Address - Country:US
Mailing Address - Phone:805-455-1150
Mailing Address - Fax:
Practice Address - Street 1:510 STATE ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-967-2024
Practice Address - Fax:805-967-7054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist