Doctor Name: | SERVANDO BENJAMIN PATLAN |
NPI Number: | 1255738027 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | 60517538 |
Business Practice Address: | 2811 75th Pl Se Apt 202 Mercer Island, WA - 980402706 |
Business Phone Number: | 3602807062 |
Business Fax Number: | |
Mailing Address: | 2811 75th Pl Se Apt 202, MERCER ISLAND |
State: | WA |
Postal Code: | 980402706 |
Phone Number: | 3602807062 |
Fax Number: | |
NPI Enumeration Date: | 11/21/2014 |
NPI Last Update Date: | 11/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 60517538 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |