Provider Demographics
NPI:1841392453
Name:MULDER, PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MULDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 CHERRY LAWN RD
Mailing Address - Street 2:STARLIGHT BEHAVIORAL HEALTH
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-302-2078
Mailing Address - Fax:304-302-7260
Practice Address - Street 1:5317 CHERRY LAWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705
Practice Address - Country:US
Practice Address - Phone:304-302-2078
Practice Address - Fax:304-302-7260
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13274Medicare UPIN
WV13274Medicare UPIN