Provider Demographics
NPI:1194543397
Name:BADOLA, PIYUSH NA (LADC)
Entity type:Individual
Prefix:MR
First Name:PIYUSH
Middle Name:NA
Last Name:BADOLA
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WATER ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2047
Mailing Address - Country:US
Mailing Address - Phone:612-598-1966
Mailing Address - Fax:651-488-0887
Practice Address - Street 1:3146 W BDE MAKA SKA BLVD APT 205
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-3277
Practice Address - Country:US
Practice Address - Phone:612-598-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)