Provider Demographics
NPI:1760055917
Name:PATRAS, NICHOLAS PAUL (PHD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PAUL
Last Name:PATRAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:PAUL
Other - Last Name:PATRAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-1316
Mailing Address - Country:US
Mailing Address - Phone:512-426-0243
Mailing Address - Fax:
Practice Address - Street 1:101 KING PLZ STE D
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-3734
Practice Address - Country:US
Practice Address - Phone:903-375-0048
Practice Address - Fax:903-246-3309
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX67647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health