Provider Demographics
NPI:1568735397
Name:PATTON, PETER L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:L
Last Name:PATTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267
Mailing Address - Country:US
Mailing Address - Phone:503-740-2245
Mailing Address - Fax:503-594-1773
Practice Address - Street 1:326 SE MARLIN AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9624
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:503-861-2043
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical