Provider Demographics
NPI:1235267170
Name:PATKO, YOLANDA ANNE (LPC)
Entity Type:Individual
Prefix:PROF
First Name:YOLANDA
Middle Name:ANNE
Last Name:PATKO
Suffix:
Gender:F
Credentials:LPC
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 22948
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76122-0001
Mailing Address - Country:US
Mailing Address - Phone:817-800-0248
Mailing Address - Fax:
Practice Address - Street 1:6106 PORTICO DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4171
Practice Address - Country:US
Practice Address - Phone:817-800-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10065842OtherAMERIGROUP