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General NPI Number Information
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NPI Number | 1104970763
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Entity Type | Individual
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Provider Name | PAUL D. FOUCAULT MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 8 W GENESEE ST
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City | IRON RIVER
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State | MI
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Zip | 49935-1435
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Country | US
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Telephone | 906-265-4428
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Fax | 906-265-4595
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Provider Business Mailing Address
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Address Line | 720 ERIE AVE
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City | CRYSTAL FALLS
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State | MI
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Zip | 49920-1111
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Country | US
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Telephone | 906-265-4428
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Fax | 906-265-4595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401001846
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License Number State | MI
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