Provider Demographics
NPI:1285472274
Name:PATTERSON, JACQUELYN R (LPC-MHSP(TEMP))
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LPC-MHSP(TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVALE
Mailing Address - State:TN
Mailing Address - Zip Code:37153-4455
Mailing Address - Country:US
Mailing Address - Phone:615-691-1774
Mailing Address - Fax:
Practice Address - Street 1:5720 HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVALE
Practice Address - State:TN
Practice Address - Zip Code:37153-4455
Practice Address - Country:US
Practice Address - Phone:615-691-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health