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NPI Code Detail

MEDICARE: ASHLEY PATTERSON MHP

MEDICARE: ASHLEY PATTERSON MHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1548497191
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY PATTERSON MHP
Provider Business Mailing Address
First Line : 100 JEFFERSON STREET
Second Line :
City : OREGON
State : IL
Zip : 61061-1609
Country : US
Telephone Number : 815-732-3157
Fax Number : 815-732-3159
Provider Business Practice Location Address
First Line : 100 JEFFERSON STREET
Second Line :
City : OREGON
State : IL
Zip : 61061-1609
Country : US
Telephone Number : 815-732-3157
Fax Number : 815-732-3159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2009
Last Update Date : 12/30/2016

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