Provider Demographics
NPI:1649324815
Name:CORREA, PATRICIA (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 LATIGO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7241
Mailing Address - Country:US
Mailing Address - Phone:915-820-7341
Mailing Address - Fax:
Practice Address - Street 1:3712 WICHITA ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-2866
Practice Address - Country:US
Practice Address - Phone:915-820-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8929101YM0800X
TX63296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health