Provider Demographics
NPI:1114155926
Name:PATTON, CLINTON C SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:C
Last Name:PATTON
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 W MEMORIAL RD # 112
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-8047
Mailing Address - Country:US
Mailing Address - Phone:405-446-5597
Mailing Address - Fax:405-378-2212
Practice Address - Street 1:4801 N CLASSEN BLVD STE 135
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4624
Practice Address - Country:US
Practice Address - Phone:405-532-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200375320AMedicaid