Provider Demographics
NPI:1679869853
Name:PERSONAL ADVANTAGE COUNSELING
Entity type:Organization
Organization Name:PERSONAL ADVANTAGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-932-3753
Mailing Address - Street 1:120 NORTHGATE MILE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2543
Mailing Address - Country:US
Mailing Address - Phone:208-932-3753
Mailing Address - Fax:
Practice Address - Street 1:120 NORTHGATE MILE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2543
Practice Address - Country:US
Practice Address - Phone:208-932-3753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health