Provider Demographics
NPI:1851369631
Name:PATTERSON, JOHN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 LONE WOLF TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2756
Mailing Address - Country:US
Mailing Address - Phone:210-536-5070
Mailing Address - Fax:210-536-3349
Practice Address - Street 1:2507 KENNEDY CIR
Practice Address - Street 2:USAFSAM/FECN
Practice Address - City:BROOKS CITY-BASE
Practice Address - State:TX
Practice Address - Zip Code:78235-5116
Practice Address - Country:US
Practice Address - Phone:210-536-5070
Practice Address - Fax:210-536-3349
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical