Provider Demographics
NPI:1629646195
Name:PATTERSON, PATRICK D (PLPC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 E KINGSLEY ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7245
Mailing Address - Country:US
Mailing Address - Phone:417-414-0333
Mailing Address - Fax:
Practice Address - Street 1:1358 E KINGSLEY ST STE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7245
Practice Address - Country:US
Practice Address - Phone:417-414-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health