Provider Demographics
NPI:1669249223
Name:PATTERSON, TARSHA (MS)
Entity type:Individual
Prefix:
First Name:TARSHA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16275
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-6275
Mailing Address - Country:US
Mailing Address - Phone:601-419-3277
Mailing Address - Fax:
Practice Address - Street 1:2035 N PUMP HOUSE LN
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-8022
Practice Address - Country:US
Practice Address - Phone:805-268-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94028039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical