Provider Demographics
NPI:1093853616
Name:MCCONNAUGHEY, PATRICK LYNN (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:LYNN
Last Name:MCCONNAUGHEY
Suffix:
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17110 MURRAY STREET
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49746-8253
Mailing Address - Country:US
Mailing Address - Phone:989-464-2505
Mailing Address - Fax:616-732-6392
Practice Address - Street 1:17110 MURRAY STREET
Practice Address - Street 2:
Practice Address - City:HILLMAN
Practice Address - State:MI
Practice Address - Zip Code:49746-8253
Practice Address - Country:US
Practice Address - Phone:989-464-2505
Practice Address - Fax:616-732-6392
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional