Provider Demographics
NPI:1447975115
Name:PRAG, PATRICK WILLIAM (LPC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:WILLIAM
Last Name:PRAG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9634
Mailing Address - Country:US
Mailing Address - Phone:720-938-3954
Mailing Address - Fax:
Practice Address - Street 1:808 S PUBLIC RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2193
Practice Address - Country:US
Practice Address - Phone:720-938-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional