Provider Demographics
NPI:1265924195
Name:PADILLA, JUAN PABLO (LMHC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:PADILLA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 100TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5513
Mailing Address - Country:US
Mailing Address - Phone:515-201-6928
Mailing Address - Fax:
Practice Address - Street 1:2963 100TH ST STE 3
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-5513
Practice Address - Country:US
Practice Address - Phone:515-201-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090848101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor