Provider Demographics
NPI:1053657056
Name:PAINTER, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PAINTER
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 1:1401 N 13TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-3139
Mailing Address - Country:US
Mailing Address - Phone:260-728-3906
Mailing Address - Fax:260-724-2617
Practice Address - Street 1:1401 N 13TH ST STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-3139
Practice Address - Country:US
Practice Address - Phone:260-728-3906
Practice Address - Fax:260-724-2617
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health