Provider Demographics
NPI:1316045909
Name:PRICE, PAULA FAY (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:FAY
Last Name:PRICE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 E WELLS ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1158
Mailing Address - Country:US
Mailing Address - Phone:309-944-7608
Mailing Address - Fax:
Practice Address - Street 1:1912 MIDDLE RD
Practice Address - Street 2:SUITE 300B
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7600
Practice Address - Country:US
Practice Address - Phone:563-349-4673
Practice Address - Fax:563-265-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health