Healthcare Provider Details

I. General information

NPI: 1447093067
Provider Name (Legal Business Name): PAUL A NORTH PLMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 10TH ST
GERING NE
69341-1724
US

IV. Provider business mailing address

401 SANDRA CT
SCOTTSBLUFF NE
69361-4349
US

V. Phone/Fax

Practice location:
  • Phone: 888-448-9665
  • Fax: 308-635-0264
Mailing address:
  • Phone: 308-635-0204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: