Provider Demographics
NPI:1699108886
Name:MATEN, PATRICIA RE'NA
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:RE'NA
Last Name:MATEN
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 1:8624 NE 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-3253
Mailing Address - Country:US
Mailing Address - Phone:405-556-1038
Mailing Address - Fax:
Practice Address - Street 1:8624 NE 33RD ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3253
Practice Address - Country:US
Practice Address - Phone:405-556-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKJ082439816101Y00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst