MEDICARE: PATTERSON BEHAVIORAL HEALTH LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1265236020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATTERSON BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	10700 BEACH BLVD UNIT 17254
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-8051
Country	:	US
Telephone Number	:	904-351-6342
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 FORT WADE RD STE 100
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5114
Country	:	US
Telephone Number	:	904-951-6342
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DE'VON PATTERSON
Credential	:	PHD
Telephone Number	:	904-351-6342

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	10/22/2025

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