MEDICARE: NATALIE MARIE PAULSON MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401224580	MI

General Provider Information

NPI Number	:	1194312215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MARIE PAULSON MA, LPC

Provider Business Mailing Address
First Line	:	1401 60TH ST SE STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7065
Country	:	US
Telephone Number	:	616-227-0725
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 60TH ST SE STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-7065
Country	:	US
Telephone Number	:	616-227-0725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	10/10/2024

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