Provider Demographics
NPI:1942303243
Name:PATTON, KELLI D (CM)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:D
Last Name:PATTON
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-2044
Mailing Address - Country:US
Mailing Address - Phone:580-445-1744
Mailing Address - Fax:
Practice Address - Street 1:1316 HUNT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2044
Practice Address - Country:US
Practice Address - Phone:580-445-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health