Provider Demographics
NPI:1770660433
Name:PATTON, PATRICIA ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELLEN
Last Name:PATTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10061 SPAR CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7401
Mailing Address - Country:US
Mailing Address - Phone:714-968-2166
Mailing Address - Fax:714-968-8349
Practice Address - Street 1:950 S COAST DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1776
Practice Address - Country:US
Practice Address - Phone:714-546-4406
Practice Address - Fax:714-546-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMJ17032101YM0800X
CAPSY12400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY124000Medicaid
CACP12400Medicare PIN