MEDICARE: MS. SALLY L. PATTON I LPC

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
1	101YP2500X	Professional Counselor	3095	OK

General Provider Information

NPI Number	:	1861671703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY L. PATTON I LPC

Provider Business Mailing Address
First Line	:	3035 NW 63RD ST STE 202
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3606
Country	:	US
Telephone Number	:	405-237-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 S DELAWARE PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-2418
Country	:	US
Telephone Number	:	918-346-4189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2007
Last Update Date	:	05/02/2024

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