Provider Demographics
NPI:1194282137
Name:WEATHERFORD, MICHAEL PATTON (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATTON
Last Name:WEATHERFORD
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E ERIE ST STE 304
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3599
Mailing Address - Country:US
Mailing Address - Phone:217-549-2542
Mailing Address - Fax:
Practice Address - Street 1:155 E ERIE ST STE 301
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3513
Practice Address - Country:US
Practice Address - Phone:217-549-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty