=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588597124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ETHAN MATTHEW PATTERSON M.ED, LPC-ASSOCIATE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 DENALI PASS STE 101
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-7979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-434-0716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1718 HARVEST BEND LN
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-4152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-434-0716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 102579
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------