Provider Demographics
NPI:1245786219
Name:PATTERSON, MEGAN CHRISTINE (RADT-1)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CHRISTINE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:CHRISTINE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RADT-1
Mailing Address - Street 1:15450 COUNTY ROAD 99
Mailing Address - Street 2:15450
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-668-9627
Mailing Address - Fax:530-668-8525
Practice Address - Street 1:15450 COUNTY ROAD 99
Practice Address - Street 2:15450
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-9339
Practice Address - Country:US
Practice Address - Phone:530-668-9627
Practice Address - Fax:530-668-8525
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEF128883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)