Provider Demographics
NPI:1326636051
Name:SAVAGE, PATTI H (LCSW-S)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:H
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HIGHWAY 47 STE 3115
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-3207
Mailing Address - Country:US
Mailing Address - Phone:979-436-0483
Mailing Address - Fax:979-436-0072
Practice Address - Street 1:2900 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2622
Practice Address - Country:US
Practice Address - Phone:979-774-8200
Practice Address - Fax:877-601-5854
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1M6502OtherMEDICARE
TX420383801Medicaid