Healthcare Provider Details

I. General information

NPI: 1639664006
Provider Name (Legal Business Name): PAUL SAHWELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOPE DR
MOUNTAIN HOME AFB ID
83648-1057
US

IV. Provider business mailing address

8315 TELEGRAPH RD APT 220
ODENTON MD
21113-1497
US

V. Phone/Fax

Practice location:
  • Phone: 208-828-7900
  • Fax:
Mailing address:
  • Phone: 202-420-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number203092
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: