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General NPI Number Information
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NPI Number | 1568691574
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Entity Type | Individual
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Provider Name | FRED HENRY PAULI L.M.H.C., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2009
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Last Update Date | 07/11/2009
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Provider Practice Location Address
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Address Line | 422 5TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-5614
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Country | US
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Telephone | 904-246-2457
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Fax | 904-246-2152
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Provider Business Mailing Address
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Address Line | PO BOX 51153
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32240-1153
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Country | US
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Telephone | 904-246-2457
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Fax | 904-246-2152
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC001249
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MH 6641
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LPC001249
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 6641
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC001249
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License Number State | GA
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