Provider Demographics
NPI:1487953303
Name:HOMER, PATRICIA A (MA, LPC, LCDC, ACTP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:HOMER
Suffix:
Gender:F
Credentials:MA, LPC, LCDC, ACTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 W WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6344
Mailing Address - Country:US
Mailing Address - Phone:432-599-5222
Mailing Address - Fax:432-262-1058
Practice Address - Street 1:3416 W WALL ST STE 106
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-599-5222
Practice Address - Fax:432-262-1058
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487953303Medicaid