Provider Demographics
NPI:1396131322
Name:PAULY, TONI ELIZABETH-IVY (CPC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:ELIZABETH-IVY
Last Name:PAULY
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 BLUE PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2512
Mailing Address - Country:US
Mailing Address - Phone:725-724-5779
Mailing Address - Fax:
Practice Address - Street 1:1321 S HWY 160
Practice Address - Street 2:STE 3E
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-1126
Practice Address - Country:US
Practice Address - Phone:725-724-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP1270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional