Provider Demographics
NPI:1336386291
Name:PICON, JOSE (BA, LADC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PICON
Suffix:
Gender:M
Credentials:BA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5014
Mailing Address - Country:US
Mailing Address - Phone:651-379-4300
Mailing Address - Fax:
Practice Address - Street 1:797 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5014
Practice Address - Country:US
Practice Address - Phone:651-379-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)