Provider Demographics
NPI:1477891802
Name:PATTON, KENNETH LEON (BA, CADC III)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LEON
Last Name:PATTON
Suffix:
Gender:M
Credentials:BA, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:BUILDING B SUIT 1B
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3565
Mailing Address - Country:US
Mailing Address - Phone:949-540-0170
Mailing Address - Fax:949-540-0173
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:BUILDING B SUIT 1B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3565
Practice Address - Country:US
Practice Address - Phone:949-540-0170
Practice Address - Fax:949-540-0173
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABII00080619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)