Provider Demographics
NPI:1871320721
Name:PATOVISTI, MADELEINE (LPC)
Entity type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:
Last Name:PATOVISTI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MADELEINE
Other - Middle Name:
Other - Last Name:HARRIGILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2104 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4614
Mailing Address - Country:US
Mailing Address - Phone:539-424-2817
Mailing Address - Fax:
Practice Address - Street 1:2104 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4614
Practice Address - Country:US
Practice Address - Phone:539-424-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health