Healthcare Provider Details

I. General information

NPI: 1750876736
Provider Name (Legal Business Name): WILLIAM DAVIS PATTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E CHESTNUT ST
CHICAGO IL
60611-2014
US

IV. Provider business mailing address

1507 W CARMEN AVE APT 3W
CHICAGO IL
60640-2898
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-8425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: