Provider Demographics
NPI:1104970763
Name:FOUCAULT, PAUL D (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:FOUCAULT
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:D
Other - Last Name:FOUCAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:720 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49920-1111
Mailing Address - Country:US
Mailing Address - Phone:906-265-4428
Mailing Address - Fax:906-265-4595
Practice Address - Street 1:8 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1435
Practice Address - Country:US
Practice Address - Phone:906-265-4428
Practice Address - Fax:906-265-4595
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional