Provider Demographics
NPI:1881805901
Name:FATATO, PAUL GENE (MA LPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GENE
Last Name:FATATO
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CARPENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9712
Mailing Address - Country:US
Mailing Address - Phone:269-962-4414
Mailing Address - Fax:269-962-5070
Practice Address - Street 1:335 CARPENTER DR
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-9712
Practice Address - Country:US
Practice Address - Phone:269-962-4414
Practice Address - Fax:269-962-5070
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health