Individual
MR. PAUL TRAVIS KERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDAC
Contact information
Practice address
305 PACIFIC AVE S STE 102, KELSO, WA 98626-1638
(360) 577-7442
(360) 577-7904
Mailing address
PO BOX 1847, LONGVIEW, WA 98632
(380) 423-0203
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP 60041391
WA
106S00000X
Behavior Technician
—
WA
171M00000X
Case Manager/Care Coordinator
16R21
OR
Other
Enumeration date
06/12/2016
Last updated
11/22/2019
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