Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 11678 | CA |
NPI | 1003349721 |
---|---|
Provider Name | James Patton |
First Address | Desert Hot Springs, CA 92240-1419 |
Second Address | Desert Hot Springs, CA 92240-1419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 05/10/2021 |