Healthcare Provider Details

I. General information

NPI: 1972806776
Provider Name (Legal Business Name): KEVIN PATRICK PADDEN LPCC, LCPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE # C2
CERES CA
95307-4562
US

IV. Provider business mailing address

1904 RICHLAND AVE # C2
CERES CA
95307-4562
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4600
  • Fax: 209-541-2549
Mailing address:
  • Phone: 209-558-4600
  • Fax: 209-541-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-4558
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: