Provider Demographics
NPI:1831418524
Name:UTIN, PATRICK G
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:UTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4308
Mailing Address - Country:US
Mailing Address - Phone:405-204-6683
Mailing Address - Fax:405-848-5619
Practice Address - Street 1:10400 VINEYARD BLVD STE E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3830
Practice Address - Country:US
Practice Address - Phone:405-848-5620
Practice Address - Fax:405-848-5619
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst