Healthcare Provider Details

I. General information

NPI: 1669915229
Provider Name (Legal Business Name): CHRISTOPHER PAULSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 COLDWATER CANYON AVE STE C
STUDIO CITY CA
91604-1478
US

IV. Provider business mailing address

907 PARKMAN AVE APT 2
LOS ANGELES CA
90026-2928
US

V. Phone/Fax

Practice location:
  • Phone: 323-590-4381
  • Fax:
Mailing address:
  • Phone: 323-590-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: