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General NPI Number Information
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NPI Number | 1114210721
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Entity Type | Individual
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Provider Name | THERESA ANN KENNEDY PATTON LCPC CRC LPC LCAC
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Gender | Female
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 617 STEPHANIE CT
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City | WASHINGTON
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State | IL
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Zip | 61571-9279
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Country | US
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Telephone | 317-799-4343
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Fax | 317-643-8989
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Provider Business Mailing Address
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Address Line | 617 STEPHANIE CT
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City | WASHINGTON
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State | IL
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Zip | 61571-9279
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Country | US
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Telephone | 317-799-4343
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Fax | 317-643-8989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1804
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15216
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180015238
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 204377
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 87001357A
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License Number State | IN
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11965125
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License Number State | WI
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 23605
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License Number State | AZ
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Taxonomy #8
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16405
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License Number State | TX
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Taxonomy #9
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2025015218
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License Number State | MO
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