Provider Demographics
NPI:1730216722
Name:POITRA, PATRICK (LPC, QMHP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:POITRA
Suffix:
Gender:M
Credentials:LPC, QMHP
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:POITRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, QMHP
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:11 EAST 4TH STREET
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-0447
Mailing Address - Country:US
Mailing Address - Phone:605-374-3862
Mailing Address - Fax:605-374-3864
Practice Address - Street 1:11 EAST 4TH ST
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57645
Practice Address - Country:US
Practice Address - Phone:605-823-4212
Practice Address - Fax:605-823-4212
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC 1167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health