Provider Demographics
NPI:1225383375
Name:PATTERSON, BERNICE S (LLP)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:S
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LLP
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 94
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:MI
Mailing Address - Zip Code:49074-0094
Mailing Address - Country:US
Mailing Address - Phone:833-342-4552
Mailing Address - Fax:
Practice Address - Street 1:5887 LARKWOOD CT APT 1B
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-6648
Practice Address - Country:US
Practice Address - Phone:833-342-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015177103T00000X
MI6361007506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist