Provider Demographics
NPI:1528165339
Name:ST. JOHN, PAULA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 FOREST PARK BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2257
Mailing Address - Country:US
Mailing Address - Phone:817-926-4462
Mailing Address - Fax:817-367-0694
Practice Address - Street 1:2501 FOREST PARK BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2257
Practice Address - Country:US
Practice Address - Phone:817-926-4462
Practice Address - Fax:817-367-0694
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical