Healthcare Provider Details

I. General information

NPI: 1144761172
Provider Name (Legal Business Name): PATRICK C.A MARCOUX MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 09/27/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 DIXIE HWY STE 155
CLARKSTON MI
48346-2095
US

IV. Provider business mailing address

39 S MAIN ST STE 2
CLARKSTON MI
48346-1590
US

V. Phone/Fax

Practice location:
  • Phone: 248-791-9266
  • Fax: 248-392-2601
Mailing address:
  • Phone: 215-543-4221
  • Fax: 844-538-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: