Provider Demographics
NPI:1487112108
Name:ARREDONDO, PAUL MIGUEL (LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MIGUEL
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6656
Mailing Address - Country:US
Mailing Address - Phone:541-973-7752
Mailing Address - Fax:
Practice Address - Street 1:141 N FRONT ST
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6656
Practice Address - Country:US
Practice Address - Phone:541-973-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL11542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health