Provider Demographics
NPI:1154791580
Name:JIM, PAUL ACE III (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ACE
Last Name:JIM
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:777 W SOUTHERN AVE BLDG E
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5008
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:541-504-1195
Practice Address - Street 1:777 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5008
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:541-504-1195
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR17-04-09101YA0400X
AZLCSW-223821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)