Provider Demographics
NPI:1841489580
Name:PATTERSON, DIANE JEANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JEANNE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:JEANNE
Other - Last Name:TRIBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1349
Mailing Address - Country:US
Mailing Address - Phone:505-388-4497
Mailing Address - Fax:505-534-1150
Practice Address - Street 1:315 S HUDSON ST
Practice Address - Street 2:SUITE 19
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6184
Practice Address - Country:US
Practice Address - Phone:505-388-4497
Practice Address - Fax:505-534-1150
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical