Individual provider · Type 1 NPI
Kevin Lee Pettus, CCS, ACADC
Addiction (Substance Use Disorder) Counselor · Challis, Idaho 83226, ID
NPI number
1265848717
Active
Practice location
25431 Hwy 93
Challis, Idaho 83226, ID 83226-8322
Mailing address
397 River Dr
Challis, ID 83226-4840
Other practice locations
- 605 11th Ave E, Gooding, ID 83330-5368 · (208) 934-8461
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12002 (ID) |
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 13012 (ID) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
About NPI 1265848717
Kevin Lee Pettus, CCS, ACADC's National Provider Identifier is 1265848717, issued on Jul 5, 2014. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Challis, Idaho 83226, ID. The record was last updated on Sep 3, 2021.