Healthcare Provider Details

I. General information

NPI: 1831401470
Provider Name (Legal Business Name): KAREN GRACE PATRICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3493 WOODS EDGE SUITE 103
OKEMOS MI
48864-5911
US

IV. Provider business mailing address

1714 S GENESEE DR
LANSING MI
48915-1237
US

V. Phone/Fax

Practice location:
  • Phone: 517-886-3707
  • Fax: 517-349-1973
Mailing address:
  • Phone: 517-374-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6801069657
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: