MEDICARE: PAULSEN CHANGE AGENT- THERAPY & COACHING LLC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1487455606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAULSEN CHANGE AGENT- THERAPY & COACHING LLC

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD STE 312
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 W CHARLESTON BLVD STE 1-124
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1401
Country	:	US
Telephone Number	:	213-215-7670
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANYEL PAULSEN
Credential	:
Telephone Number	:	213-215-7670

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	12/05/2025

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