Provider Demographics
NPI:1720122997
Name:MCGINNIS, PATRICK BRYAN (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:BRYAN
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:B
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:6416 5TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9649
Mailing Address - Country:US
Mailing Address - Phone:772-766-9161
Mailing Address - Fax:
Practice Address - Street 1:6416 5TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-9649
Practice Address - Country:US
Practice Address - Phone:772-766-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5190101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)