Provider Demographics
NPI:1982940045
Name:FERRELL, PAUL IRA I (CADC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:IRA
Last Name:FERRELL
Suffix:I
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1423
Mailing Address - Country:US
Mailing Address - Phone:248-745-6940
Mailing Address - Fax:248-745-6922
Practice Address - Street 1:54 SENECA STREET
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2349
Practice Address - Country:US
Practice Address - Phone:248-334-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630950324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility