Healthcare Provider Details

I. General information

NPI: 1255408811
Provider Name (Legal Business Name): PAUL F STRAND LCSW,CADCIII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WALNUT ST SUITE 706
GREEN BAY WI
54301-4239
US

IV. Provider business mailing address

130 E WALNUT ST SUITE 706
GREEN BAY WI
54301-4239
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-8256
  • Fax: 920-437-1188
Mailing address:
  • Phone: 920-437-8256
  • Fax: 920-437-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number4147-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: