Provider Demographics
NPI:1316402167
Name:BILLUPS, PATRICK (EDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BILLUPS
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 N GENESEE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1141
Mailing Address - Country:US
Mailing Address - Phone:304-550-4487
Mailing Address - Fax:
Practice Address - Street 1:52 N GENESEE ST APT 2
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1141
Practice Address - Country:US
Practice Address - Phone:304-550-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0605113103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool