Provider Demographics
NPI:1790459170
Name:PATTISON, SAMUEL BARKER (LMHCP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BARKER
Last Name:PATTISON
Suffix:
Gender:
Credentials:LMHCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 UNIVERSITY AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1470
Mailing Address - Country:US
Mailing Address - Phone:402-807-3666
Mailing Address - Fax:
Practice Address - Street 1:2700 UNIVERSITY AVE STE 308
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1470
Practice Address - Country:US
Practice Address - Phone:402-807-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health