MEDICARE: MS. PATTY GAIL PATTEN M.S.,LPC,LMFT,LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1	OK
2	101YP2500X	Professional Counselor	1189	OK
3	106H00000X	Marriage & Family Therapist	244	OK

General Provider Information

NPI Number	:	1407058639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATTY GAIL PATTEN M.S.,LPC,LMFT,LADC

Provider Business Mailing Address
First Line	:	3808 MEADOW LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-5432
Country	:	US
Telephone Number	:	918-284-0733
Fax Number	:	405-285-8760

Provider Business Practice Location Address
First Line	:	1700 W BRITTON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1312
Country	:	US
Telephone Number	:	405-818-1585
Fax Number	:	405-285-8760

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	03/22/2010

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