Provider Demographics
NPI:1558373365
Name:PANTHER, PATRICIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PANTHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2530 ELDORADO PKWY
Mailing Address - Street 2:SUITE 205-A
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4398
Mailing Address - Country:US
Mailing Address - Phone:469-617-7451
Mailing Address - Fax:469-617-7451
Practice Address - Street 1:2530 ELDORADO PKWY
Practice Address - Street 2:SUITE 205-A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4398
Practice Address - Country:US
Practice Address - Phone:469-617-7451
Practice Address - Fax:469-617-7451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical