Provider Demographics
NPI:1770533192
Name:PATTERSON, KIM CASHMAN (MFT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:CASHMAN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N LANTANA ST
Mailing Address - Street 2:SUITE 269
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-9010
Mailing Address - Country:US
Mailing Address - Phone:805-230-4009
Mailing Address - Fax:805-484-1828
Practice Address - Street 1:333 N LANTANA ST
Practice Address - Street 2:SUITE 269
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-9010
Practice Address - Country:US
Practice Address - Phone:805-230-4009
Practice Address - Fax:805-484-1828
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT38943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist