Healthcare Provider Details

I. General information

NPI: 1730466616
Provider Name (Legal Business Name): PARADISE CREEK COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W 3RD ST
MOSCOW ID
83843-2204
US

IV. Provider business mailing address

325 W 3RD ST
MOSCOW ID
83843-2204
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2566
  • Fax:
Mailing address:
  • Phone: 208-882-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DAN BAYLY
Title or Position: CO-MANAGER
Credential:
Phone: 208-596-2542