MEDICARE: MS. PATRICIA MICHELLE CARRINGTON 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	101YP2500X	Professional Counselor	7366-125	WI

General Provider Information

NPI Number	:	1013574409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA MICHELLE CARRINGTON LPC

Provider Business Mailing Address
First Line	:	10105 W COLDSPRING RD APT 106
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-2632
Country	:	US
Telephone Number	:	414-559-0845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 E CAPITOL DR STE 202
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-1959
Country	:	US
Telephone Number	:	414-963-8711
Fax Number	:	866-545-1113

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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