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General NPI Number Information
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NPI Number | 1386989903
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Entity Type | Individual
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Provider Name | DALLAS PAUL NORMAN MS, LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 3830 S CUSHMAN ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-7530
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Country | US
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Telephone | 907-455-5238
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Fax |
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Provider Business Mailing Address
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Address Line | 5582 CASCADE RD
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City | FAIRBANKS
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State | AK
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Zip | 99709-5811
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Country | US
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Telephone | 907-455-5238
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 782
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License Number State | AK
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