Provider Demographics
NPI:1649418492
Name:PATTON, LYNETTE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:M
Last Name:PATTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3043
Mailing Address - Country:US
Mailing Address - Phone:314-885-0788
Mailing Address - Fax:618-344-0071
Practice Address - Street 1:415 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234
Practice Address - Country:US
Practice Address - Phone:314-885-0788
Practice Address - Fax:618-344-7793
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004554101YM0800X
IL1490207271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health