Basic Information
| Provider Information | |||||||||
| NPI: | 1639180136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSCW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1670 | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847131670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4354387100 | ||||||||
| FaxNumber: | 4354387166 | ||||||||
| Practice Location | |||||||||
| Address1: | 1109 N 100 WEST | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847131670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4354387100 | ||||||||
| FaxNumber: | 4354387166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 333616-3501 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.