Provider Demographics
NPI:1114945516
Name:PATTERSON, MICHAEL EUGENE (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EUGENE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14407 LAQUINTA DR
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-4107
Mailing Address - Country:US
Mailing Address - Phone:816-806-3399
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:6220 BLUE RIDGE CUTOFF STE 302
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3730
Practice Address - Country:US
Practice Address - Phone:816-806-3399
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496146705Medicaid