Healthcare Provider Details

I. General information

NPI: 1316556913
Provider Name (Legal Business Name): MITCHELL PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W BROAD ST
COLUMBUS OH
43222-1319
US

IV. Provider business mailing address

PO BOX 132
ATHENS OH
45701-0132
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-8293
  • Fax:
Mailing address:
  • Phone: 800-321-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0001916
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2308951
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC162815
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: