Provider Demographics
NPI:1003140609
Name:PATIN, FRANK CHARLES (LPC)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:CHARLES
Last Name:PATIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1651
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568
Mailing Address - Country:US
Mailing Address - Phone:715-892-1673
Mailing Address - Fax:
Practice Address - Street 1:306 HWY 70 E
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-8800
Practice Address - Country:US
Practice Address - Phone:715-892-1673
Practice Address - Fax:715-365-6768
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI574-226101YM0800X
WI4595-125101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100015604Medicaid