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 Field Definition 1
1 NPI 1528365251 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name PATRICK The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name MICHELLE The first name of the provider, if the provider is an individual.
5 Provider Middle Name RENEE The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text PH.D. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 611 N FOUNTAIN ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name CAPE GIRARDEAU The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name MO The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 637017244 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 5736512705 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 5739864994 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 2/15/2011 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 1/8/2013 The date that a record was last updated or changed.
17 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
18 Healthcare Provider Taxonomy Code 1 103T00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 LP 1649 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 KS The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 N
22 Healthcare Provider Taxonomy Code 2 103T00000X
23 Provider License Number 2 2012038439 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
24 Provider License Number State Code 2 MO The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 2 Y
26 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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