Provider Demographics
NPI:1003974395
Name:PATTERSON, JAMES M (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0688
Mailing Address - Country:US
Mailing Address - Phone:541-298-5000
Mailing Address - Fax:541-296-3296
Practice Address - Street 1:119 E 2ND ST
Practice Address - Street 2:#208
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1796
Practice Address - Country:US
Practice Address - Phone:541-298-5000
Practice Address - Fax:541-296-3296
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02 07 45101YA0400X
ORL29861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR02 07 45Medicaid
OR139670Medicaid
OR139670Medicaid