Healthcare Provider Details

I. General information

NPI: 1679539944
Provider Name (Legal Business Name): PAUL H AEX MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE SUITE 110
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 40
GLENWOOD SPRINGS CO
81602-0040
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-3478
  • Fax: 970-668-0632
Mailing address:
  • Phone: 970-945-2241
  • Fax: 970-945-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number986041
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: