Healthcare Provider Details

I. General information

NPI: 1992235576
Provider Name (Legal Business Name): EDITH H PATAGUNDI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W SOUTH BOUNDARY ST BLDG 6
PERRYSBURG OH
43551-5235
US

IV. Provider business mailing address

950 S 1ST ST
LOUISVILLE KY
40203-2202
US

V. Phone/Fax

Practice location:
  • Phone: 614-339-0806
  • Fax:
Mailing address:
  • Phone: 502-585-9444
  • Fax: 502-585-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number173535
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103819
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number262144
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: