Provider Demographics
NPI:1659982163
Name:PATTERSON, TAMARA L
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 RIVER PLACE BVLD
Mailing Address - Street 2:#105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730
Mailing Address - Country:US
Mailing Address - Phone:855-444-5664
Mailing Address - Fax:
Practice Address - Street 1:6611 RIVER PLACE BVLD
Practice Address - Street 2:#105
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730
Practice Address - Country:US
Practice Address - Phone:855-444-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-24-73443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst