Provider Demographics
NPI:1730570698
Name:WILLIAMS, PAMELA
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-0679
Mailing Address - Country:US
Mailing Address - Phone:325-893-4010
Mailing Address - Fax:325-893-4042
Practice Address - Street 1:1712 NORTH ACCESS ROAD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510-0679
Practice Address - Country:US
Practice Address - Phone:325-893-4010
Practice Address - Fax:325-893-4042
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional