Provider Demographics
NPI:1316597784
Name:PATTERSON, TANYA NICOLE (AMFT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:NICOLE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14350 CIVIC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2342
Mailing Address - Country:US
Mailing Address - Phone:760-949-2819
Mailing Address - Fax:
Practice Address - Street 1:14350 CIVIC DR STE 100
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2342
Practice Address - Country:US
Practice Address - Phone:760-949-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist