Healthcare Provider Details

I. General information

NPI: 1093853616
Provider Name (Legal Business Name): PATRICK LYNN MCCONNAUGHEY LICENSED PROFESSIONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 10/02/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17110 MURRAY STREET
HILLMAN MI
49746-8253
US

IV. Provider business mailing address

17110 MURRAY STREET
HILLMAN MI
49746-8253
US

V. Phone/Fax

Practice location:
  • Phone: 989-464-2505
  • Fax: 616-732-6392
Mailing address:
  • Phone: 989-464-2505
  • Fax: 616-732-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: