Provider Demographics
NPI:1326133521
Name:PATTON, LISA M (MSW, LCSW, RPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:PATTON
Suffix:
Gender:F
Credentials:MSW, LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 WOOD HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8559
Mailing Address - Country:US
Mailing Address - Phone:317-873-4292
Mailing Address - Fax:317-873-4540
Practice Address - Street 1:1555 W OAK ST
Practice Address - Street 2:SUITE 70
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1896
Practice Address - Country:US
Practice Address - Phone:317-873-4292
Practice Address - Fax:317-873-4540
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004957A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical