Provider Demographics
NPI:1144761172
Name:MARCOUX, PATRICK CA (MS, LPC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:CA
Last Name:MARCOUX
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1590
Mailing Address - Country:US
Mailing Address - Phone:215-543-4221
Mailing Address - Fax:844-538-1691
Practice Address - Street 1:7640 DIXIE HWY STE 155
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2095
Practice Address - Country:US
Practice Address - Phone:248-791-9266
Practice Address - Fax:248-392-2601
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health