Provider Demographics
NPI:1831401470
Name:PATRICK, KAREN GRACE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:GRACE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 S GENESEE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1237
Mailing Address - Country:US
Mailing Address - Phone:517-374-6173
Mailing Address - Fax:
Practice Address - Street 1:3493 WOODS EDGE
Practice Address - Street 2:SUITE 103
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5911
Practice Address - Country:US
Practice Address - Phone:517-886-3707
Practice Address - Fax:517-349-1973
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional