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General NPI Number Information
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NPI Number | 1649606575
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Entity Type | Organization
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Legal Business Name | PADRON COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 543 3RD ST
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3909
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Country | US
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Telephone | 208-522-6925
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Fax | 208-522-6934
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Provider Business Mailing Address
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Address Line | 543 3RD ST
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3909
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Country | US
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Telephone | 208-522-6925
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Fax | 208-522-6934
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Authorized Official
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Title or Position | CEO
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Name | MR. JORGE PADRON
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Credential | CADC
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Telephone | 208-589-4139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | ID
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