Provider Demographics
NPI:1275884470
Name:MINGLE, PAM J (LCSW)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:J
Last Name:MINGLE
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 1:144 COUNTRY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6212
Mailing Address - Country:US
Mailing Address - Phone:512-437-1367
Mailing Address - Fax:
Practice Address - Street 1:144 COUNTRY KNOLL DR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6212
Practice Address - Country:US
Practice Address - Phone:512-437-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical