Provider Demographics
NPI:1366651341
Name:PATTERSON, ROBERT BALDWIN
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BALDWIN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:BALDWIN
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 630564
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-0564
Mailing Address - Country:US
Mailing Address - Phone:936-552-9525
Mailing Address - Fax:
Practice Address - Street 1:510 OCHILTREE ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4408
Practice Address - Country:US
Practice Address - Phone:936-552-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278101YP2500X
TX30207103TS0200X
TX743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist