Healthcare Provider Details

I. General information

NPI: 1659817047
Provider Name (Legal Business Name): PATRICK METTLE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 PINEY CREEK DR
BLACKLICK OH
43004-7071
US

IV. Provider business mailing address

265 PINEY CREEK DR
BLACKLICK OH
43004-7071
US

V. Phone/Fax

Practice location:
  • Phone: 614-286-7800
  • Fax: 614-286-7800
Mailing address:
  • Phone: 614-625-7183
  • Fax: 614-221-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1901024
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: