Provider Demographics
NPI:1164770301
Name:PATRICK, SEAN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:PATRICK
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1371
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-1371
Mailing Address - Country:US
Mailing Address - Phone:406-823-0231
Mailing Address - Fax:
Practice Address - Street 1:40 2ND ST E STE 230
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6114
Practice Address - Country:US
Practice Address - Phone:406-823-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT523464Medicaid