Healthcare Provider Details

I. General information

NPI: 1255397527
Provider Name (Legal Business Name): PATRICK K FAIRCLOTH MA. LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6482 COUNTY ROAD 2262
TROY AL
36079-3234
US

IV. Provider business mailing address

6482 COUNTY ROAD 2262
TROY AL
36079-3234
US

V. Phone/Fax

Practice location:
  • Phone: 586-839-5513
  • Fax:
Mailing address:
  • Phone: 586-839-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC03277
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: