Provider Demographics
NPI:1104547561
Name:PAULSEN, RICHARD WALLACE (COUNSELOR)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WALLACE
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28805
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-8805
Mailing Address - Country:US
Mailing Address - Phone:509-484-4021
Mailing Address - Fax:
Practice Address - Street 1:9507 N DIVISION ST STE G
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1553
Practice Address - Country:US
Practice Address - Phone:509-484-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601650528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health