=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912481631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA DE OLIVEIRA SANTOS MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2018
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1361 FRANCIS ST STE 201D
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-322-9910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1628 FLEMMING DR
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 80501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-322-9910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | NLC.0108694
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------