Provider Demographics
NPI:1497109805
Name:PATTON, MICHAEL JOEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:PATTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BELMONT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2427
Mailing Address - Country:US
Mailing Address - Phone:606-401-2966
Mailing Address - Fax:606-244-4111
Practice Address - Street 1:250 BELMONT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2427
Practice Address - Country:US
Practice Address - Phone:606-401-2966
Practice Address - Fax:606-244-4111
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional