Healthcare Provider Details

I. General information

NPI: 1003140609
Provider Name (Legal Business Name): FRANK CHARLES PATIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HWY 70 E
SAINT GERMAIN WI
54558-8800
US

IV. Provider business mailing address

PO BOX 1651
WOODRUFF WI
54568
US

V. Phone/Fax

Practice location:
  • Phone: 715-892-1673
  • Fax: 715-365-6768
Mailing address:
  • Phone: 715-892-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number574-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4595-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4595-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: