Provider Demographics
NPI:1427015437
Name:TANNEHILL, PAMELA J (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:TANNEHILL
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 1:324 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6647
Mailing Address - Country:US
Mailing Address - Phone:479-986-0566
Mailing Address - Fax:479-986-0599
Practice Address - Street 1:324 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6647
Practice Address - Country:US
Practice Address - Phone:479-986-0566
Practice Address - Fax:479-986-0599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1978-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X542Medicare ID - Type Unspecified