Provider Demographics
NPI:1396551727
Name:PATTERSON, TARYN LACEY
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:LACEY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47122 TIMBER RUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW WATERFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44445-8712
Mailing Address - Country:US
Mailing Address - Phone:330-921-9044
Mailing Address - Fax:
Practice Address - Street 1:3649 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9385
Practice Address - Country:US
Practice Address - Phone:330-270-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health