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General NPI Number Information
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NPI Number | 1750890786
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Entity Type | Organization
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Legal Business Name | Z BOOST PERFORMANCE
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1110 10TH AVE STE L4
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City | MENOMINEE
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State | MI
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Zip | 49858-3058
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Country | US
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Telephone | 906-290-2444
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Fax | 844-270-0756
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Provider Business Mailing Address
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Address Line | 1110 10TH AVE STE L4
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City | MENOMINEE
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State | MI
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Zip | 49858-3058
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Country | US
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Telephone | 906-290-2444
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Fax | 844-270-0756
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL COUNSELOR
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Name | CHRISTINE MARIE PADA
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Credential | LCP
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Telephone | 906-290-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401013488
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License Number State | MI
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