Provider Demographics
NPI:1861953317
Name:PATTERSON, GEORGETTE I (CPC INTERN)
Entity type:Individual
Prefix:MRS
First Name:GEORGETTE
Middle Name:I
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:CPC INTERN
Other - Prefix:
Other - First Name:GEORGETTE
Other - Middle Name:I
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 61523
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89006-1523
Mailing Address - Country:US
Mailing Address - Phone:702-686-9153
Mailing Address - Fax:
Practice Address - Street 1:5450 W SAHARA AVE STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0383
Practice Address - Country:US
Practice Address - Phone:702-686-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty