Healthcare Provider Details

I. General information

NPI: 1023813367
Provider Name (Legal Business Name): PATRICK POWER LLC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 REMEMBRANCE RD NW STE 3
GRAND RAPIDS MI
49534-7745
US

IV. Provider business mailing address

3755 REMEMBRANCE RD NW STE 3
GRAND RAPIDS MI
49534-7745
US

V. Phone/Fax

Practice location:
  • Phone: 616-737-1304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024131
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: