Healthcare Provider Details

I. General information

NPI: 1144139692
Provider Name (Legal Business Name): STACIE PATTON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 7TH ST
CAPE CORAL FL
33993-1801
US

IV. Provider business mailing address

110 NW 7TH ST
CAPE CORAL FL
33993-1801
US

V. Phone/Fax

Practice location:
  • Phone: 614-887-7770
  • Fax:
Mailing address:
  • Phone: 614-887-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: