MR. KEVIN LEE PETTUS CCS ACADC NPI 1265848717

NPI Information

NPI: 1265848717
Provider Name: MR. KEVIN LEE PETTUS, CCS, ACADC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
25431 HWY 93
CHALLIS, IDAHO 83226, ID
ZIP 83226
Phone: (208) 879-2267
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MR. Kevin Lee Pettus, CCS, ACADC is an addiction (substance use disorder) counselor in Challis, Idaho 83226, ID. MR. Kevin Lee Pettus, CCS, ACADC NPI is 1265848717. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

25431 HWY 93
CHALLIS, IDAHO 83226, ID
ZIP 83226-322
Phone: (208) 879-2267

The enumeration date for this NPI number is 7/5/2014 and was last updated on 9/3/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	12002	IDAHO	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	13012	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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