Provider Demographics
NPI:1588285191
Name:DEMORE, PAULA MARIE (JD, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:MARIE
Last Name:DEMORE
Suffix:
Gender:F
Credentials:JD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E MARLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1120
Mailing Address - Country:US
Mailing Address - Phone:602-315-2869
Mailing Address - Fax:
Practice Address - Street 1:103 E MARLETTE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1120
Practice Address - Country:US
Practice Address - Phone:602-315-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health