Individual
PATRICK MEDLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LMHC, LMFT
Contact information
Practice address
655 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5523
(812) 335-5890
(812) 355-5895
Mailing address
655 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5523
(812) 335-5890
(812) 355-5895
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
34002601A
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
34002601A
IN
101YM0800X
Mental Health Counselor
39000428A
IN
1041C0700X
Clinical Social Worker
Primary
34002601A
IN
106H00000X
Marriage & Family Therapist
35000705A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316246
ANTHEM
—
Enumeration date
03/04/2006
Last updated
04/29/2009
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