Provider Demographics
NPI:1851114177
Name:PATRICK, JEFFREY PAUL
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:PATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11470 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7010
Mailing Address - Country:US
Mailing Address - Phone:740-550-4991
Mailing Address - Fax:
Practice Address - Street 1:11470 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-7010
Practice Address - Country:US
Practice Address - Phone:740-550-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.190494101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)