Provider Demographics
NPI:1497332175
Name:PATRICK, NICOLE TERESE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:TERESE
Last Name:PATRICK
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 1:3030 FALL MIST DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3228
Mailing Address - Country:US
Mailing Address - Phone:848-216-6368
Mailing Address - Fax:
Practice Address - Street 1:6923 W LOOP 1604 N STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2631
Practice Address - Country:US
Practice Address - Phone:210-446-6454
Practice Address - Fax:210-314-4671
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional