MEDICARE: MS. PATRICIA ELLEN PATTON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC27419	CA
2	103TC0700X	Clinical Psychologist	PSY13266	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC27419	OTHER	CA	BOARD OF BEHAVIORAL SCIEN
2	PSY13266	OTHER	CA	BOARD OF PSYCHOLOGY LCP

General Provider Information

NPI Number	:	1104964311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA ELLEN PATTON PHD

Provider Business Mailing Address
First Line	:	72877 DINAH SHORE DR STE 103
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2709
Country	:	US
Telephone Number	:	661-733-5355
Fax Number	:

Provider Business Practice Location Address
First Line	:	471 SUNNINGDALE DR
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1445
Country	:	US
Telephone Number	:	661-733-5355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	02/24/2023

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