Basic Information
| Provider Information | |||||||||
| NPI: | 1538298724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS-PATTON | ||||||||
| FirstName: | IKETIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 RIDGETOP CIR | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633044514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787636322 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4411 N NEWSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631152534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145311770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC005058 | GA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 2012013272 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.