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General NPI Number Information
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NPI Number | 1366651341
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Entity Type | Individual
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Provider Name | MR. ROBERT BALDWIN PATTERSON
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 510 OCHILTREE ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4408
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Country | US
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Telephone | 936-552-9525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 630564
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City | NACOGDOCHES
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State | TX
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Zip | 75963-0564
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Country | US
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Telephone | 936-552-9525
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 278
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 30207
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 743
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License Number State | TX
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