Provider Demographics
NPI:1386796746
Name:HANKS, PATRICIA LAURA (LLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LAURA
Last Name:HANKS
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9716
Mailing Address - Country:US
Mailing Address - Phone:269-605-9287
Mailing Address - Fax:
Practice Address - Street 1:6800 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-9716
Practice Address - Country:US
Practice Address - Phone:269-605-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013233103TB0200X
IN39001558A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health