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General NPI Number Information
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NPI Number | 1477010460
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Entity Type | Individual
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Provider Name | PAUL VANDAELE MA; LPC
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Gender | Male
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 3350 W AMERICANA TER STE 210B
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City | BOISE
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State | ID
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Zip | 83706-2521
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Country | US
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Telephone | 720-212-7446
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Fax |
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Provider Business Mailing Address
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Address Line | 2646 N COLUMBINE AVE
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City | BOISE
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State | ID
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Zip | 83713-5257
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Country | US
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Telephone | 720-212-7446
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Fax | 208-485-8911
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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 | LPC-5781
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License Number State | ID
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