Provider Demographics
NPI:1215429618
Name:PUGH, PATRINA MILTON
Entity type:Individual
Prefix:
First Name:PATRINA
Middle Name:MILTON
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 N JEFFERSON PLACE CIR APT D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7638
Mailing Address - Country:US
Mailing Address - Phone:225-229-8884
Mailing Address - Fax:
Practice Address - Street 1:7312 N JEFFERSON PLACE CIR APT D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7638
Practice Address - Country:US
Practice Address - Phone:225-229-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty