Healthcare Provider Details

I. General information

NPI: 1811766686
Provider Name (Legal Business Name): JIM PAULUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S LINCOLN ST
HILLSBORO KS
67063-1714
US

IV. Provider business mailing address

211 WEST GRAND
HILLSBORO KS
67063
US

V. Phone/Fax

Practice location:
  • Phone: 620-869-9986
  • Fax:
Mailing address:
  • Phone: 620-877-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: