Provider Demographics
NPI:1821584541
Name:THAKUR, PATRICIA (CRADC, CCDP, CS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:THAKUR
Suffix:
Gender:F
Credentials:CRADC, CCDP, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 E LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7458
Mailing Address - Country:US
Mailing Address - Phone:417-396-9025
Mailing Address - Fax:
Practice Address - Street 1:404 E BATTLEFIELD ST # R
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4802
Practice Address - Country:US
Practice Address - Phone:417-865-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7849101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)