Provider Demographics
NPI:1497184949
Name:ED PATTON
Entity type:Organization
Organization Name:ED PATTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAMFT
Authorized Official - Phone:507-884-6287
Mailing Address - Street 1:1530 GREENVIEW DR SW STE 115
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1080
Mailing Address - Country:US
Mailing Address - Phone:507-884-6287
Mailing Address - Fax:507-258-4022
Practice Address - Street 1:1530 GREENVIEW DR SW STE 115
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1080
Practice Address - Country:US
Practice Address - Phone:507-884-6287
Practice Address - Fax:507-258-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty