MEDICARE: CASSANDRA FAYE PATTERSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401015962	MI
2	101YP2500X	Professional Counselor	6401017265	MI
3	101Y00000X	Counselor	6401017265	MI

General Provider Information

NPI Number	:	1013441161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA FAYE PATTERSON LPC

Provider Business Mailing Address
First Line	:	PO BOX 140241
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49514-0241
Country	:	US
Telephone Number	:	616-735-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 E BELTLINE AVE NE
Second Line	:	BUILDING 3, STE 303
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9350
Country	:	US
Telephone Number	:	616-202-2762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2017
Last Update Date	:	03/21/2024

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