Provider Demographics
NPI:1639550924
Name:PATTERSON, ISRAEL
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 W SOUTH JORDAN PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4712
Mailing Address - Country:US
Mailing Address - Phone:801-255-1155
Mailing Address - Fax:801-255-0281
Practice Address - Street 1:1258 W SOUTH JORDAN PKWY STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4712
Practice Address - Country:US
Practice Address - Phone:801-255-1155
Practice Address - Fax:801-255-0281
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6492884-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health