Provider Demographics
NPI:1477667277
Name:PATCH, ANDREW JOHN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:PATCH
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VILLA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1144
Mailing Address - Country:US
Mailing Address - Phone:262-619-3264
Mailing Address - Fax:262-619-3263
Practice Address - Street 1:700 VILLA ST
Practice Address - Street 2:SUITE A
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1144
Practice Address - Country:US
Practice Address - Phone:262-619-3264
Practice Address - Fax:262-619-3263
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2898-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional