1730216722 NPI number — MR. PATRICK POITRA LPC, QMHP

Table of content: MR. PATRICK POITRA LPC, QMHP (NPI 1730216722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730216722 NPI number — MR. PATRICK POITRA LPC, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POITRA
Provider First Name:
PATRICK
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, QMHP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POITRA
Provider Other First Name:
PAT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, QMHP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730216722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 447
Provider Second Line Business Mailing Address:
11 EAST 4TH STREET
Provider Business Mailing Address City Name:
LEMMON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57638-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-374-3862
Provider Business Mailing Address Fax Number:
605-374-3864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 EAST 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMMON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-823-4212
Provider Business Practice Location Address Fax Number:
605-823-4212
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC 1167 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com