Provider Demographics
NPI:1487412979
Name:PATTERSON, JENNIFER DIANE (MA, AMFT #142362)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DIANE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MA, AMFT #142362
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-1106
Mailing Address - Country:US
Mailing Address - Phone:619-736-4711
Mailing Address - Fax:
Practice Address - Street 1:1380 LEAD HILL BLVD STE 145
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2998
Practice Address - Country:US
Practice Address - Phone:916-740-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist