Healthcare Provider Details

I. General information

NPI: 1326307398
Provider Name (Legal Business Name): DR. MONICA L PATTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 CORDILLERA WAY
EDWARDS CO
81632-6290
US

IV. Provider business mailing address

7993 MILLSTONE CT
SEVERN MD
21144-1740
US

V. Phone/Fax

Practice location:
  • Phone: 970-693-0015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number205183
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0002161
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: