Provider Demographics
NPI:1730466616
Name:PARADISE CREEK COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:PARADISE CREEK COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-596-2542
Mailing Address - Street 1:619 S WASHINGTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3090
Mailing Address - Country:US
Mailing Address - Phone:208-596-2542
Mailing Address - Fax:
Practice Address - Street 1:619 S WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3090
Practice Address - Country:US
Practice Address - Phone:208-596-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty