Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LASAC-13200 | AZ |
Y | 103G00000X | Clinical Psychologist | 094308 | IA |
Y | 103TC0700X | Clinical Psychologist | 094308 | IA |
NPI | 1003122805 |
---|---|
Provider Name | David B Paul |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50314-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117079 | (05) | AZ |