MEDICARE: MRS. IKETIA WILLIAMS-PATTON LPC

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	101YM0800X	Mental Health Counselor	LPC005058	GA
2	101YM0800X	Mental Health Counselor	2012013272	MO

General Provider Information

NPI Number	:	1538298724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IKETIA WILLIAMS-PATTON LPC

Provider Business Mailing Address
First Line	:	803 RIDGETOP CIR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-4514
Country	:	US
Telephone Number	:	678-763-6322
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 N NEWSTEAD AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2534
Country	:	US
Telephone Number	:	314-531-1770
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/31/2012

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Directions to “ MRS. IKETIA WILLIAMS-PATTON LPC” Practice Location

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