Provider Demographics
NPI:1558342030
Name:GUILFORD, PATRICIA MOULTON (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MOULTON
Last Name:GUILFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1673
Mailing Address - Country:US
Mailing Address - Phone:269-383-0248
Mailing Address - Fax:269-344-8696
Practice Address - Street 1:5930 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1673
Practice Address - Country:US
Practice Address - Phone:269-383-0248
Practice Address - Fax:269-344-8696
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M44550Medicare ID - Type Unspecified