Provider Demographics
NPI:1275823601
Name:PATTON, ANNE PARKS (QMHA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:PARKS
Last Name:PATTON
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:PARKS
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:4847 13TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3813
Mailing Address - Country:US
Mailing Address - Phone:503-505-3901
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORANNEVALDEZMedicaid