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NPI Code Detail

MEDICARE: EDWARD RAY PACHEL LADC

MEDICARE: EDWARD RAY PACHEL LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor301528MN

General Provider Information

NPI Number : 1275711608
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD RAY PACHEL LADC
Provider Business Mailing Address
First Line : 1000 8TH ST SE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-2819
Country : US
Telephone Number : 218-847-0696
Fax Number : 218-847-4198
Provider Business Practice Location Address
First Line : 1000 8TH ST SE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-2819
Country : US
Telephone Number : 218-847-0696
Fax Number : 218-847-4198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2008
Last Update Date : 02/07/2008

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Directions to “ EDWARD RAY PACHEL LADC” Practice Location

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