Healthcare Provider Details

I. General information

NPI: 1518605666
Provider Name (Legal Business Name): PATRICE PATTON-CAMPBELL LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 PEARSON ST
MATTESON IL
60443-3110
US

IV. Provider business mailing address

5012 PEARSON ST
MATTESON IL
60443-3110
US

V. Phone/Fax

Practice location:
  • Phone: 708-941-1052
  • Fax:
Mailing address:
  • Phone: 708-941-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.018203
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: