Healthcare Provider Details

I. General information

NPI: 1114945516
Provider Name (Legal Business Name): MICHAEL EUGENE PATTERSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 BLUE RIDGE CUTOFF STE 302
RAYTOWN MO
64133-3730
US

IV. Provider business mailing address

14407 LAQUINTA DR
GRANDVIEW MO
64030-4107
US

V. Phone/Fax

Practice location:
  • Phone: 816-806-3399
  • Fax: --
Mailing address:
  • Phone: 816-806-3399
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003031779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: