Provider Demographics
NPI:1912723404
Name:DR JACOB ANDREW PAULSEN PHD LICENSED CLINICAL PSYCHOLOGIST INC
Entity type:Organization
Organization Name:DR JACOB ANDREW PAULSEN PHD LICENSED CLINICAL PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-800-5499
Mailing Address - Street 1:PO BOX 3573
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1573
Mailing Address - Country:US
Mailing Address - Phone:619-800-5499
Mailing Address - Fax:
Practice Address - Street 1:1399 9TH AVE APT 1517
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4700
Practice Address - Country:US
Practice Address - Phone:619-800-5499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)