=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528169034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA F. HARRY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 OREGON ST STE A-2
-----------------------------------------------------
City | OSHKOSH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54902-7001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-410-7364
-----------------------------------------------------
Fax | 920-230-2898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 OREGON ST STE A-2
-----------------------------------------------------
City | OSHKOSH
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54902-7001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-410-7364
-----------------------------------------------------
Fax | 920-230-2898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1809-123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------