Provider Demographics
NPI:1457483695
Name:PATTON, KATHLEEN GOWAN (MS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GOWAN
Last Name:PATTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 WEST ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1725
Mailing Address - Country:US
Mailing Address - Phone:530-246-4700
Mailing Address - Fax:530-244-4747
Practice Address - Street 1:1724 WEST ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1725
Practice Address - Country:US
Practice Address - Phone:530-246-4700
Practice Address - Fax:530-244-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist