Provider Demographics
NPI:1154530418
Name:DODD, PAUL WAYNE (DMIN, LPC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WAYNE
Last Name:DODD
Suffix:
Gender:M
Credentials:DMIN, LPC
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 151613
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1613
Mailing Address - Country:US
Mailing Address - Phone:512-731-7716
Mailing Address - Fax:512-291-0535
Practice Address - Street 1:8701 MOSQUERO CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5267
Practice Address - Country:US
Practice Address - Phone:512-291-5555
Practice Address - Fax:512-291-0535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional