Healthcare Provider Details

I. General information

NPI: 1356637904
Provider Name (Legal Business Name): CAROL JEAN PATTERSON LPCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 12/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT MICHAELS DR STUDENT HEALTH CENTER
SANTA FE NM
87505-7615
US

IV. Provider business mailing address

1600 SAINT MICHAELS DR STUDENT HEALTH CENTER
SANTA FE NM
87505-7615
US

V. Phone/Fax

Practice location:
  • Phone: 505-473-6362
  • Fax:
Mailing address:
  • Phone: 505-473-6362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60160858
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC0176101
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0012189
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: