=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649180555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PPC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2026
-----------------------------------------------------
Last Update Date | 09/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 PICABO STREET, UNIT 102
-----------------------------------------------------
City | KETCHUM
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-309-2815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4486
-----------------------------------------------------
City | KETCHUM
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83340-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-309-2815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MADISON FERRIS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 208-309-2815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------