Provider Demographics
NPI:1306220421
Name:SOUTH, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SOUTH
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 1:3160 TELEGRAPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3250
Mailing Address - Country:US
Mailing Address - Phone:805-642-4611
Mailing Address - Fax:805-585-3241
Practice Address - Street 1:3160 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3250
Practice Address - Country:US
Practice Address - Phone:805-642-4611
Practice Address - Fax:805-585-3241
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-165841041C0700X
CALCSW914161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical