=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972946598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTORIA PAULUS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2013
-----------------------------------------------------
Last Update Date | 04/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7600 NE 41ST ST STE 310
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-571-2050
-----------------------------------------------------
Fax | 360-253-3196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7600 NE 41ST ST STE 310
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-571-2050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VICTORIA DAWN PAULUS
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 360-571-2050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | AP30004268
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------