Provider Demographics
NPI:1962821090
Name:WALCHAK, PATRICK (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:WALCHAK
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3344
Mailing Address - Country:US
Mailing Address - Phone:517-507-5892
Mailing Address - Fax:
Practice Address - Street 1:3970 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3344
Practice Address - Country:US
Practice Address - Phone:517-507-5892
Practice Address - Fax:517-258-2951
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010937781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical