Provider Demographics
NPI:1588961502
Name:ALDERTON PATTULLO, DEBRA K (LPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:ALDERTON PATTULLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N RED OAK RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MI
Mailing Address - Zip Code:49756-7531
Mailing Address - Country:US
Mailing Address - Phone:989-745-2531
Mailing Address - Fax:
Practice Address - Street 1:831 W. MILLER ROAD
Practice Address - Street 2:MCOG
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647
Practice Address - Country:US
Practice Address - Phone:989-745-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007327101Y00000X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist