Provider Demographics
NPI:1912943002
Name:KADIS, PAUL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:KADIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W NORTH COLLEGE ST
Mailing Address - Street 2:THE HUMANIST CENTER, SUITE 8
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1500
Mailing Address - Country:US
Mailing Address - Phone:937-767-9700
Mailing Address - Fax:
Practice Address - Street 1:105 W NORTH COLLEGE ST
Practice Address - Street 2:THE HUMANIST CENTER, SUITE 8
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1500
Practice Address - Country:US
Practice Address - Phone:937-767-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4091103TC0700X, 103TA0400X, 103TC2200X, 103TB0200X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0832442Medicaid
OHCP06082Medicare PIN