Provider Demographics
NPI:1467189860
Name:PATRICK, FAITHE (MA, LMHP)
Entity Type:Individual
Prefix:
First Name:FAITHE
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17358 447TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7629
Mailing Address - Country:US
Mailing Address - Phone:605-520-1279
Mailing Address - Fax:
Practice Address - Street 1:12100 W CENTER RD STE 518
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3960
Practice Address - Country:US
Practice Address - Phone:402-933-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health