Provider Demographics
NPI:1174283543
Name:PATTERSON, CHEYENNE LEE (RADT-1)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:LEE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RADT-1
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 1666
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-1666
Mailing Address - Country:US
Mailing Address - Phone:530-626-9240
Mailing Address - Fax:
Practice Address - Street 1:5494 PONY EXPRESS TRAIL
Practice Address - Street 2:
Practice Address - City:CAMINO
Practice Address - State:CA
Practice Address - Zip Code:95709
Practice Address - Country:US
Practice Address - Phone:530-626-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1453741221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)