Provider Demographics
NPI:1487022513
Name:PATTON, RENEE ANN (PHD LCPC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANN
Last Name:PATTON
Suffix:
Gender:F
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 TURTLE CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9506
Mailing Address - Country:US
Mailing Address - Phone:814-440-9415
Mailing Address - Fax:
Practice Address - Street 1:1003 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9646
Practice Address - Country:US
Practice Address - Phone:309-444-1000
Practice Address - Fax:309-444-7000
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001977101YP2500X
PAPC003427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional