Provider Demographics
NPI:1063139558
Name:PATTON, HAROLD GLENN (DIRECTOR)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:GLENN
Last Name:PATTON
Suffix:
Gender:M
Credentials:DIRECTOR
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Mailing Address - Street 1:15133 MATEO PRADO WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-3723
Mailing Address - Country:US
Mailing Address - Phone:909-963-9262
Mailing Address - Fax:760-628-2098
Practice Address - Street 1:732 S ACACIA AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7106
Practice Address - Country:US
Practice Address - Phone:909-258-2478
Practice Address - Fax:760-628-2098
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
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Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)