Healthcare Provider Details

I. General information

NPI: 1063422764
Provider Name (Legal Business Name): MS. ROBIN J. PATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 CHURCHILL CT
DE SOTO MO
63020-4711
US

IV. Provider business mailing address

1132 CHURCHILL CT
DE SOTO MO
63020-4711
US

V. Phone/Fax

Practice location:
  • Phone: 314-541-4925
  • Fax: 636-337-5230
Mailing address:
  • Phone: 314-541-4925
  • Fax: 636-337-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2004014266
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: