Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 4595-125 | WI |
N | 101YM0800X | Mental Health Counselor | 574-226 | WI |
Y | 101YP2500X | Professional Counselor | 4595-125 | WI |
NPI | 1003140609 |
---|---|
Provider Name | Mr. Frank Charles Patin |
First Address | Woodruff, WI 54568 |
Second Address | Saint Germain, WI 54558-8800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 30/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100015604 | (05) | WI |