Provider Demographics
NPI:1861040339
Name:PATTERSON, MARISSA PAIGE
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:PAIGE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 W 10TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-2189
Mailing Address - Country:US
Mailing Address - Phone:559-801-9518
Mailing Address - Fax:
Practice Address - Street 1:75 PARK CREEK DR STE 104
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4432
Practice Address - Country:US
Practice Address - Phone:559-460-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst