Provider Demographics
NPI:1104964311
Name:PATTON, PATRICIA ELLEN (PHD)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:PATTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:PATICIA
Other - Middle Name:ELLEN
Other - Last Name:PATTON LEHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:72877 DINAH SHORE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2709
Mailing Address - Country:US
Mailing Address - Phone:661-733-5355
Mailing Address - Fax:
Practice Address - Street 1:471 SUNNINGDALE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1445
Practice Address - Country:US
Practice Address - Phone:661-733-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27419106H00000X
CAPSY13266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC27419OtherBOARD OF BEHAVIORAL SCIEN
CAPSY13266OtherBOARD OF PSYCHOLOGY LCP