Provider Demographics
NPI:1053191445
Name:PATRIE, ANN HOLLINGSWORTH (M A)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:HOLLINGSWORTH
Last Name:PATRIE
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:TX
Mailing Address - Zip Code:78069-1030
Mailing Address - Country:US
Mailing Address - Phone:210-262-9012
Mailing Address - Fax:
Practice Address - Street 1:14831 MAIN ST
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-9641
Practice Address - Country:US
Practice Address - Phone:210-262-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83887101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health