Provider Demographics
NPI:1528140753
Name:SALAAM, PAMELA FULTON (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:FULTON
Last Name:SALAAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 TIMBER SHADOWS DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2041
Mailing Address - Country:US
Mailing Address - Phone:832-330-2567
Mailing Address - Fax:775-383-9620
Practice Address - Street 1:2330 TIMBER SHADOWS DR
Practice Address - Street 2:SUITE 208
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2041
Practice Address - Country:US
Practice Address - Phone:832-330-2567
Practice Address - Fax:775-383-9620
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSALAPAMEOtherCORPHEALTH
TX270291OtherCOMPSYCH
TX370977OtherMHN
TX50MXOtherBLUE CROSS BLUE SHIELD
TX612108Medicare ID - Type Unspecified