Provider Demographics
NPI:1154031482
Name:PATRICK PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:PATRICK PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-509-5032
Mailing Address - Street 1:2843 E GRAND RIVER
Mailing Address - Street 2:BOX 120
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4989
Mailing Address - Country:US
Mailing Address - Phone:810-588-7426
Mailing Address - Fax:
Practice Address - Street 1:1525 GILCREST AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1841
Practice Address - Country:US
Practice Address - Phone:810-588-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0972747OtherBCBSM PIN
15584284OtherCAQH ID
MI6801114283OtherSTATE LICENSE NUMBER