Healthcare Provider Details

I. General information

NPI: 1891425294
Provider Name (Legal Business Name): RAYO PASCAL BUDGE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E 2ND N
REXBURG ID
83440-1605
US

IV. Provider business mailing address

393 E 2ND N
REXBURG ID
83440-1605
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-4840
  • Fax: 208-359-9010
Mailing address:
  • Phone: 208-359-4840
  • Fax: 208-359-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-9099
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: