Provider Demographics
NPI:1366462517
Name:MURPH, PAMELA SHANDS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SHANDS
Last Name:MURPH
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 1:445 RIDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-3529
Mailing Address - Country:US
Mailing Address - Phone:865-216-6693
Mailing Address - Fax:865-932-4488
Practice Address - Street 1:4869 CHAMBLISS AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5122
Practice Address - Country:US
Practice Address - Phone:865-216-6693
Practice Address - Fax:865-932-4488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000037081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3927174Medicaid
TN4107557OtherBCBS
TN3927174Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER