Provider Demographics
NPI:1104425214
Name:DUFFY, PAUL LEWIS
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LEWIS
Last Name:DUFFY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 CULLEN AVE APT 220
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2454
Mailing Address - Country:US
Mailing Address - Phone:512-579-1917
Mailing Address - Fax:
Practice Address - Street 1:COUNSELING SERVICES
Practice Address - Street 2:1625 RUTHERFORD LN.
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754
Practice Address - Country:US
Practice Address - Phone:512-651-6100
Practice Address - Fax:512-651-6101
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional