Provider Demographics
NPI:1548693336
Name:DEGREY, PAUL M
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:DEGREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W 100 N
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-2131
Mailing Address - Country:US
Mailing Address - Phone:435-283-8400
Mailing Address - Fax:435-283-8401
Practice Address - Street 1:152 N 400 W
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-5549
Practice Address - Country:US
Practice Address - Phone:435-283-8400
Practice Address - Fax:435-283-8401
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health