Provider Demographics
NPI:1053977587
Name:KANNARD, PAUL DOULAS (AMFT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DOULAS
Last Name:KANNARD
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0400
Mailing Address - Country:US
Mailing Address - Phone:530-529-4019
Mailing Address - Fax:
Practice Address - Street 1:1445 VISTA WAY
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4510
Practice Address - Country:US
Practice Address - Phone:530-529-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist