Provider Demographics
NPI:1275167645
Name:GRILLIOT, PATRICK ALAN (LSW, CDCA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALAN
Last Name:GRILLIOT
Suffix:
Gender:
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1877
Mailing Address - Country:US
Mailing Address - Phone:419-238-1695
Mailing Address - Fax:
Practice Address - Street 1:1229 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1877
Practice Address - Country:US
Practice Address - Phone:419-238-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.176637101YA0400X
OHS.2106161104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)