Provider Demographics
NPI:1982084349
Name:PADDOCK COUNSELING PLLC
Entity Type:Organization
Organization Name:PADDOCK COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-638-5316
Mailing Address - Street 1:201 N MITCHELL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1859
Mailing Address - Country:US
Mailing Address - Phone:231-884-0028
Mailing Address - Fax:888-977-1502
Practice Address - Street 1:201 N MITCHELL ST STE 204
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1859
Practice Address - Country:US
Practice Address - Phone:231-884-0028
Practice Address - Fax:888-977-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty