MR. KEVIN LEE PETTUS (NPI# 1265848717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265848717 |
| Entity Type | Individual |
| Full Name | MR. KEVIN LEE PETTUS |
| Credential | CADC |
| Practice Address |
605 11th Ave E Gooding ID 83330-5368 |
| Mailing Address |
1254 Twin Villa Loop Twin Falls ID 83301-8018 |
| Practice Telephone | 2089348461 |
| Mailing Telephone | 2083202518 |
| Enumeration Date | 2014-07-05 |
| Last Update Date | 2014-07-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
10197 | ID | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679641609 | Kevin Pettus | Legal Medicine | 7786 Lexington Rd, Lancaster, KY 40444-9119 | 2006-11-30 |
| Street Address |
605 11TH AVE E |
| City | GOODING |
| State | ID |
| Zip Code | 83330-5368 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861500035 | The Walker Center for Alcoholism & Drug Abuse, Inc. | Substance Abuse Rehabilitation Facility | 605 11th Ave E, Gooding, ID 83330-5368 | 2006-08-28 |
| 1033754551 | Taylor Anne Van Holland | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2019-11-07 |
| 1558818906 | Jennifer K Ford | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2016-09-01 |
| 1467813196 | John Mason | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2016-03-08 |
| 1902286099 | Justin Hiroshi Hirasaki | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2015-06-03 |
| 1710374301 | The Walker Center | Substance Abuse Rehabilitation Facility | 605 11th Ave E, Gooding, ID 83330-5368 | 2015-04-21 |
| 1235533217 | Shawnee B Legarreta | Substance Abuse Rehabilitation Facility | 605 11th Ave E, Gooding, ID 83330-5368 | 2014-10-20 |
| 1568807808 | Danny O'dell | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2013-04-30 |
| 1225384514 | Doyle Drury | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2012-07-24 |
| 1427338714 | Wayne Kauppila | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2011-08-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346648227 | Erin Orloff | Speech-Language Pathologist | 202 14th St Ave E, Gooding, ID 83330 | 2014-12-09 |
| 1518377019 | North Canyon Medical Center, Inc. | Clinic/Center | 267 N. Canyon Drive, Gooding, ID 83330 | 2014-05-06 |
| 1083959332 | Lydia Jo Missal | Counselor | 1832 E. 1750 S., Gooding, ID 83330 | 2012-11-27 |
| 1013240910 | Marcella Louise Heil | Speech-Language Pathologist | 1735 South 1800 East, Gooding, ID 83330 | 2009-09-09 |
| 1861561094 | Thomas Ernest Pryor | Family Medicine | 121 5th Ave West, Gooding, ID 83330 | 2006-11-06 |
| 1942212600 | Marcy Lin Morrow | Physician Assistant | 134 4th Ave W, Gooding Family Physicians, Gooding, ID 83330 | 2006-08-12 |
| 1174535835 | Ian B Kunz | Physician Assistant | 267 N Canyon Drive, Gooding, ID 83330 | 2006-08-12 |
| 1326002650 | Associates In Family Practice Pa | Family Medicine | 425 Idaho St, Gooding, ID 83330 | 2006-04-13 |
| 1497719728 | Mark D Spencer | Family Medicine | 425 Idaho Street, Gooding, ID 83330 | 2006-04-13 |
| 1871115717 | Megan George | Counselor | 1832 E 1750 S, Gooding, ID 83330 | 2020-05-14 |
| Find all providers in zip 83330 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558818906 | Jennifer K Ford | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2016-09-01 |
| 1467813196 | John Mason | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2016-03-08 |
| 1902286099 | Justin Hiroshi Hirasaki | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2015-06-03 |
| 1568807808 | Danny O'dell | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2013-04-30 |
| 1225384514 | Doyle Drury | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2012-07-24 |
| 1427338714 | Wayne Kauppila | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2011-08-18 |
| 1356637458 | Bridget Hurd | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2011-06-27 |
| 1073748851 | Gamile Yow | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2009-05-21 |
| 1720221625 | Sarah L. Bickford-thorpe | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2009-04-08 |
| 1306002498 | Carmalin S Resz | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2008-07-29 |
| Find all providers in GOODING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.