Provider Demographics
NPI:1114108685
Name:PATTERSON, CHARLES CLINT (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CLINT
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GEORGEFF RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-5269
Mailing Address - Country:US
Mailing Address - Phone:310-944-1420
Mailing Address - Fax:310-541-3062
Practice Address - Street 1:22 GEORGEFF RD
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS
Practice Address - State:CA
Practice Address - Zip Code:90274-5269
Practice Address - Country:US
Practice Address - Phone:310-944-1420
Practice Address - Fax:310-541-3062
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical