Provider Demographics
NPI:1225313067
Name:PATRICE EVANS COUNSELING, PLLC
Entity Type:Organization
Organization Name:PATRICE EVANS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:MAREE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-387-6404
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-0435
Mailing Address - Country:US
Mailing Address - Phone:906-387-6404
Mailing Address - Fax:906-387-6405
Practice Address - Street 1:N3936 W LOST LAKE RD
Practice Address - Street 2:
Practice Address - City:WETMORE
Practice Address - State:MI
Practice Address - Zip Code:49895-9581
Practice Address - Country:US
Practice Address - Phone:906-387-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680185455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639364706OtherINDIVIDUAL NPI