Provider Demographics
NPI:1558018473
Name:PAUL, JAMES GERALD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GERALD
Last Name:PAUL
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 1:10875 GRANDVIEW DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1510
Mailing Address - Country:US
Mailing Address - Phone:913-214-1120
Mailing Address - Fax:
Practice Address - Street 1:10875 GRANDVIEW DR STE 2200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1510
Practice Address - Country:US
Practice Address - Phone:913-214-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBACB550476106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician