Provider Demographics
NPI:1609207497
Name:CRIST, PATRICIA S (LBSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:CRIST
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LIVINGSTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8351
Mailing Address - Country:US
Mailing Address - Phone:989-732-6292
Mailing Address - Fax:989-732-0780
Practice Address - Street 1:800 LIVINGSTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8351
Practice Address - Country:US
Practice Address - Phone:989-732-6292
Practice Address - Fax:989-732-0780
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802063017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker