MEDICARE: PADDOCK COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982084349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PADDOCK COUNSELING PLLC

Provider Business Mailing Address
First Line	:	201 N MITCHELL ST STE 204
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-1859
Country	:	US
Telephone Number	:	231-884-0028
Fax Number	:	888-977-1502

Provider Business Practice Location Address
First Line	:	201 N MITCHELL ST STE 204
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-1859
Country	:	US
Telephone Number	:	231-884-0028
Fax Number	:	888-977-1502

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	BRENNA LEIGH EDWARDS
Credential	:
Telephone Number	:	231-638-5316

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	12/22/2025

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