Organization
PARK AVENUE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA PEDEN LCPC (CEO)
(801) 400-4739
Entity
Organization
Contact information
Practice address
130 N 3772 E, RIGBY, ID 83442-5316
(801) 400-4739
Mailing address
130 N 3772 E, RIGBY, ID 83442-5316
(801) 400-4739
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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