Provider Demographics
NPI:1174603641
Name:GABOURY, PAULA LYNN (MA, CPRP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LYNN
Last Name:GABOURY
Suffix:
Gender:F
Credentials:MA, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13221 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2159
Mailing Address - Country:US
Mailing Address - Phone:952-895-9304
Mailing Address - Fax:612-435-7201
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:612-435-7230
Practice Address - Fax:612-435-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN512231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health