Provider Demographics
NPI:1396345104
Name:PRETORIUS, PATRICIA JEAN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:PRETORIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:PRETORIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BHP CDC-I
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:OLD HARBOR
Mailing Address - State:AK
Mailing Address - Zip Code:99643-0072
Mailing Address - Country:US
Mailing Address - Phone:907-486-1384
Mailing Address - Fax:
Practice Address - Street 1:102 ELDERBERRY STREET
Practice Address - Street 2:
Practice Address - City:OLD HARBOR
Practice Address - State:AK
Practice Address - Zip Code:99643
Practice Address - Country:US
Practice Address - Phone:907-286-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor