Organization Name: | PATRICE EVANS COUNSELING, PLLC |
NPI Number: | 1225313067 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATRICE MAREE EVANS (OUTPATIENT CLINICIAN) |
Mailing Address: | 202 Elm Ave Suite 2 Munising |
State: | MI US |
Postal Code: | 498621108 |
Phone Number: | 9063876404 |
Fax Number: | 9063876405 |
NPI Enumeration Date: | 10/12/2011 |
NPI Last Update Date: | 10/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 680185455 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |