Healthcare Provider Details

I. General information

NPI: 1770402646
Provider Name (Legal Business Name): PAUL CHING MA, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 HAMLINE AVE N STE A
SAINT PAUL MN
55113-3181
US

IV. Provider business mailing address

2565 HAMLINE AVE N STE A
SAINT PAUL MN
55113-3181
US

V. Phone/Fax

Practice location:
  • Phone: 651-330-6205
  • Fax: 651-330-8718
Mailing address:
  • Phone: 651-330-6205
  • Fax: 651-330-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC05701
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: