Provider Demographics
NPI:1225153661
Name:DAVY, PAMELA A (LCSW LIMHP LMHP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:DAVY
Suffix:
Gender:F
Credentials:LCSW LIMHP LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HERITAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341
Mailing Address - Country:US
Mailing Address - Phone:402-441-9700
Mailing Address - Fax:
Practice Address - Street 1:4110 AVENUE D
Practice Address - Street 2:PANHANDLE MENTAL HEALTH CENTER
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-635-3171
Practice Address - Fax:308-635-9672
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE977101YM0800X
NE053101YM0800X
NE0111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical