Provider Demographics
NPI:1902371065
Name:PATRICK, MICHELLE (LPCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 POPLAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-8956
Mailing Address - Country:US
Mailing Address - Phone:740-574-4539
Mailing Address - Fax:
Practice Address - Street 1:1607 POPLAR FORK RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8956
Practice Address - Country:US
Practice Address - Phone:740-574-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103094101YP2500X
OHE.0002431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional