Provider Demographics
NPI:1104060649
Name:ESPINOZA, PATRICIA G (LLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:G
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 NORTH BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426
Mailing Address - Country:US
Mailing Address - Phone:616-262-7572
Mailing Address - Fax:616-457-1950
Practice Address - Street 1:1836 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8901
Practice Address - Country:US
Practice Address - Phone:616-457-0016
Practice Address - Fax:616-457-1950
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010112207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist