Basic Information
| Provider Information | |||||||||
| NPI: | 1326636051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAVAGE | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | LCSW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8441 STATE HIGHWAY 47 STE 3115 | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778073207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9794360483 | ||||||||
| FaxNumber: | 9794360072 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 E 29TH ST | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778022622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797748200 | ||||||||
| FaxNumber: | 8776015854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2021 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 24584 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1M6502 | 01 | TX | MEDICARE | OTHER | 420383801 | 05 | TX | MEDICAID |