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General NPI Number Information
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NPI Number | 1386690527
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Entity Type | Individual
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Provider Name | KEN PATRIQUIN MS, LPC, CAADC
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 651 N STATE ST
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City | CARO
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State | MI
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Zip | 48723-1543
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Country | US
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Telephone | 989-673-5700
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Fax | 989-672-2555
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Provider Business Mailing Address
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Address Line | 443 N STATE ST
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City | CARO
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State | MI
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Zip | 48723-1539
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Country | US
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Telephone | 989-672-6160
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Fax | 989-672-5649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401009582
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License Number State | MI
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