Provider Demographics
NPI:1376840843
Name:PTAK, PATRICIA KOZLOWSKI (MA LPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KOZLOWSKI
Last Name:PTAK
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46160 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3543
Mailing Address - Country:US
Mailing Address - Phone:734-416-8526
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2675
Practice Address - Country:US
Practice Address - Phone:248-347-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional