MEDICARE: PATRICK POWER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6451024131	MI

General Provider Information

NPI Number	:	1023813367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK POWER LLC

Provider Business Mailing Address
First Line	:	3755 REMEMBRANCE RD NW STE 3
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-7745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 REMEMBRANCE RD NW STE 3
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-7745
Country	:	US
Telephone Number	:	616-737-1304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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Directions to “ PATRICK POWER LLC” Practice Location

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