DR. MICHELLE RENEE PATRICK, PH.D. - NPI NUMBER 1528365251

Summary

Provider Name: DR. MICHELLE RENEE PATRICK, PH.D.

NPI Number: 1528365251

Clasification: Psychologist (103T00000X)

Address:
611 N FOUNTAIN ST
CAPE GIRARDEAU, MO
ZIP 63701

Phone Number: (573) 651-2705



Detailed Information

DR. Michelle Renee Patrick, PH.D. is a psychologist in Cape Girardeau, MO. The provider is a psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. The assigned NPI number for this provider is 1528365251 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

611 N FOUNTAIN ST
CAPE GIRARDEAU, MO
ZIP 63701-244
Phone: (573) 651-2705
Fax: (573) 986-4994

The enumeration date for this NPI number is 2/15/2011 and was last updated on 1/8/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103T00000X Psychologist LP 1649 KS No
2 103T00000X Psychologist 2012038439 MO Yes

NPI Record

No. Field Name Field Value
1 NPI 1528365251
2 Entity Type Code 1
3 Provider Last Name Legal Name PATRICK
4 Provider First Name MICHELLE
5 Provider Middle Name RENEE
6 Provider Name Prefix Text DR.
7 Provider Credential Text PH.D.
8 Provider First Line Business Practice Location Address 611 N FOUNTAIN ST
9 Provider Business Practice Location Address City Name CAPE GIRARDEAU
10 Provider Business Practice Location Address State Name MO
11 Provider Business Practice Location Address Postal Code 637017244
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 5736512705
14 Provider Business Practice Location Address Fax Number 5739864994
15 Provider Enumeration Date 2/15/2011
16 Last Update Date 1/8/2013
17 Provider Gender Code F
18 Healthcare Provider Taxonomy Code 1 103T00000X
19 Provider License Number 1 LP 1649
20 Provider License Number State Code 1 KS
21 Healthcare Provider Primary Taxonomy Switch 1 N
22 Healthcare Provider Taxonomy Code 2 103T00000X
23 Provider License Number 2 2012038439
24 Provider License Number State Code 2 MO
25 Healthcare Provider Primary Taxonomy Switch 2 Y
26 Is Sole Proprietor N

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This page was last updated on: 9/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.