Provider Demographics
NPI:1568781912
Name:KYLER, PAMELA A (MA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:KYLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4007
Mailing Address - Country:US
Mailing Address - Phone:409-720-9097
Mailing Address - Fax:409-293-4543
Practice Address - Street 1:320 N. 12TH STREET
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4007
Practice Address - Country:US
Practice Address - Phone:409-720-9097
Practice Address - Fax:409-293-4543
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213351402Medicaid
TX213351401Medicaid