Provider Demographics
NPI:1265745152
Name:HART, PATRICK ERWIN (LPCC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ERWIN
Last Name:HART
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 18TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:E GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-2257
Mailing Address - Country:US
Mailing Address - Phone:218-779-0134
Mailing Address - Fax:
Practice Address - Street 1:1125 18TH AVE SE
Practice Address - Street 2:
Practice Address - City:E GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-2257
Practice Address - Country:US
Practice Address - Phone:218-779-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN468869101YS0200X
ND416266101YS0200X
ND797-8-1-14101YP2500X
MN685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool