Provider Demographics
NPI:1235600511
Name:PADOC INC
Entity Type:Organization
Organization Name:PADOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC BCBA
Authorized Official - Phone:989-551-5653
Mailing Address - Street 1:6556 OLD ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-8917
Mailing Address - Country:US
Mailing Address - Phone:989-551-5653
Mailing Address - Fax:
Practice Address - Street 1:6556 OLD ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-8917
Practice Address - Country:US
Practice Address - Phone:989-551-5653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty