Provider Demographics
NPI:1295407542
Name:COURSEAULT, PAMELA THERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:THERESA
Last Name:COURSEAULT
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 1:3710 JACK BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4068
Mailing Address - Country:US
Mailing Address - Phone:580-583-6520
Mailing Address - Fax:
Practice Address - Street 1:3710 JACK BARNES AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4068
Practice Address - Country:US
Practice Address - Phone:580-583-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical