Provider Demographics
NPI:1861671703
Name:PATTON, SALLY L I (LPC)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:L
Last Name:PATTON
Suffix:I
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3635
Mailing Address - Country:US
Mailing Address - Phone:918-794-2487
Mailing Address - Fax:
Practice Address - Street 1:4414 E 23RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3635
Practice Address - Country:US
Practice Address - Phone:918-794-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional