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Provider Information for 1982445227


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PAUL DOHEARTY


Sex: Male

NPI: 1982445227
Last Updated: 2024-06-18
Certification Date: 2024-06-18

Details

NameValue
NPI1982445227
Enumeration Date2024-06-03
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 22 FOREST GLEN DR
BELLEVILLE, IL 62223-1800
United States

Phone: 314-399-1910 | Fax:
 
Primary Practice Address 11102 LINDBERGH BUSINESS CT
SAINT LOUIS, MO 63123-7810
United States

Phone: 314-399-1910 | Fax:
 
Secondary Practice Address(es)

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS, MO 63139-1101
United States

Phone: 314-206-3700 | Fax:
 

22 FOREST GLEN DR
BELLEVILLE, IL 62223-1800
United States

Phone: 314-399-1910 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YM0800X - Counselor - Mental HealthMO2021047114
Yes 101YA0400X - Counselor - Addiction (Substance Use Disorder)MO2021047114