Provider Demographics
NPI:1699105783
Name:PAULISON, DEBRA (CAC11)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:PAULISON
Suffix:
Gender:F
Credentials:CAC11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2421
Mailing Address - Country:US
Mailing Address - Phone:970-308-5184
Mailing Address - Fax:
Practice Address - Street 1:1612 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2421
Practice Address - Country:US
Practice Address - Phone:970-308-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007628101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)