Provider Demographics
NPI:1023634672
Name:PADRON COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:PADRON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-6925
Mailing Address - Street 1:522 LOMAX ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2634
Mailing Address - Country:US
Mailing Address - Phone:208-522-6925
Mailing Address - Fax:208-522-6925
Practice Address - Street 1:522 LOMAX ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2634
Practice Address - Country:US
Practice Address - Phone:208-522-6925
Practice Address - Fax:208-522-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health