Provider Demographics
NPI:1275679607
Name:KEELING-NUTTALL, PAMELA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:KEELING-NUTTALL
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 1:2220 UNION AVE
Mailing Address - Street 2:ALLIANCE HEALTH CARE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-369-1480
Mailing Address - Fax:908-788-6110
Practice Address - Street 1:2220 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-369-1480
Practice Address - Fax:908-788-6110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052364001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical