Provider Demographics
NPI:1609932300
Name:PATTERSON, MELLIE FAYE (LCSW)
Entity type:Individual
Prefix:
First Name:MELLIE
Middle Name:FAYE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 331
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84542-0331
Mailing Address - Country:US
Mailing Address - Phone:435-637-7574
Mailing Address - Fax:
Practice Address - Street 1:23 SOUTH CARBON AVE STE 10
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-4852
Practice Address - Fax:435-637-6037
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT279767-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical