Provider Demographics
NPI:1487925046
Name:PATCH, ALLISON RENEE (LMFT 95402)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:PATCH
Suffix:
Gender:F
Credentials:LMFT 95402
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16885 W BERNARDO DR STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1619
Mailing Address - Country:US
Mailing Address - Phone:424-543-4942
Mailing Address - Fax:
Practice Address - Street 1:16885 W BERNARDO DR STE 122
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1619
Practice Address - Country:US
Practice Address - Phone:424-543-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT95402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist