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NPI Code Detail

MEDICARE: MR. PATRICK JOSEPH COUSINEAU RSW

MEDICARE: MR. PATRICK JOSEPH COUSINEAU RSW
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
1101YM0800XMental Health Counselor6801086256MI

General Provider Information

NPI Number : 1104975366
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PATRICK JOSEPH COUSINEAU RSW
Provider Business Mailing Address
First Line : 301 S CRAPO ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-2941
Country : US
Telephone Number : 989-772-5938
Fax Number : 989-779-2371
Provider Business Practice Location Address
First Line : 301 S CRAPO ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-2941
Country : US
Telephone Number : 989-772-5938
Fax Number : 989-779-2371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 07/08/2007

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