Provider Demographics
NPI:1225114457
Name:PATTERSON, JOSEPH RUSSELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RUSSELL
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 1:16951 S OLD SOUOITA HWY
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641
Mailing Address - Country:US
Mailing Address - Phone:520-762-5298
Mailing Address - Fax:520-762-5874
Practice Address - Street 1:16951 S OLD SOUOITA HWY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641
Practice Address - Country:US
Practice Address - Phone:520-762-5298
Practice Address - Fax:520-762-5874
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0639103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ545189Medicaid