Provider Demographics
NPI:1194094128
Name:PATTERSON, HEATH RYAN (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:RYAN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 JACK WARNER PKWY NE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-1060
Mailing Address - Country:US
Mailing Address - Phone:205-454-0065
Mailing Address - Fax:
Practice Address - Street 1:1301 JACK WARNER PKWY NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-1060
Practice Address - Country:US
Practice Address - Phone:205-454-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1350103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical