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NPI Code Detail

MEDICARE: MR. PAUL DELBERT OTTO LMFT

MEDICARE: MR. PAUL DELBERT OTTO LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorLMFT10251AZ

General Provider Information

NPI Number : 1437213659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL DELBERT OTTO LMFT
Provider Business Mailing Address
First Line : PO BOX 579
Second Line :
City : SAINT JOHNS
State : AZ
Zip : 85936-0579
Country : US
Telephone Number : 928-337-4301
Fax Number :
Provider Business Practice Location Address
First Line : 470 W. CLEVELAND
Second Line :
City : SAINT JOHNS
State : AZ
Zip : 85936-0579
Country : US
Telephone Number : 928-337-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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