Healthcare Provider Details

I. General information

NPI: 1891056511
Provider Name (Legal Business Name): TERRI PATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16155 W 12 MILE RD SUITE 2
SOUTHFIELD MI
48076-2951
US

IV. Provider business mailing address

16155 W 12 MILE RD SUITE 2
SOUTHFIELD MI
48076-2951
US

V. Phone/Fax

Practice location:
  • Phone: 248-996-9625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: