Provider Demographics
NPI:1003455098
Name:GEORGE, PAMELA DAWN (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAWN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109
Mailing Address - Country:US
Mailing Address - Phone:806-341-4200
Mailing Address - Fax:
Practice Address - Street 1:3807 S. VIRGINIA
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-341-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health