Provider Demographics
NPI:1255461059
Name:PROCTOR, PATRICIA LYNN (MED, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MED, LPC-MHSP
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC-MHSP
Mailing Address - Street 1:6305 LONAS DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3767
Mailing Address - Country:US
Mailing Address - Phone:865-588-3173
Mailing Address - Fax:
Practice Address - Street 1:6305 LONAS DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3767
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:423-763-4657
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02546101YM0800X
TN2546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005434Medicaid
TN2546OtherLPC-MHSP