Basic Information
| Provider Information | |||||||||
| NPI: | 1831401470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATRICK | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1714 S GENESEE DR | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489151237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173746173 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3493 WOODS EDGE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488645911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178863707 | ||||||||
| FaxNumber: | 5173491973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6801069657 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.