Healthcare Provider Details

I. General information

NPI: 1750890786
Provider Name (Legal Business Name): Z BOOST PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 10TH AVE STE L4
MENOMINEE MI
49858-3058
US

IV. Provider business mailing address

1110 10TH AVE STE L4
MENOMINEE MI
49858-3058
US

V. Phone/Fax

Practice location:
  • Phone: 906-290-2444
  • Fax: 844-270-0756
Mailing address:
  • Phone: 906-290-2444
  • Fax: 844-270-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013488
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MARIE PADA
Title or Position: OWNER/PROFESSIONAL COUNSELOR
Credential: LCP
Phone: 906-290-2444