Healthcare Provider Details

I. General information

NPI: 1609920081
Provider Name (Legal Business Name): DEBORAH R PATTILLO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 25TH AVE SUITE #504
OCALA FL
34470-5675
US

IV. Provider business mailing address

1111 NE 25TH AVE SUITE #504
OCALA FL
34470-5675
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-2889
  • Fax: 352-351-9495
Mailing address:
  • Phone: 352-351-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT#2145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: