Provider Demographics
NPI:1568676963
Name:SMITH, PAMELA ANN (LBSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ABILENE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-6402
Mailing Address - Country:US
Mailing Address - Phone:806-274-9057
Mailing Address - Fax:
Practice Address - Street 1:130 ABILENE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-6402
Practice Address - Country:US
Practice Address - Phone:806-274-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04726171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator