Provider Demographics
NPI:1609175785
Name:JONES, PAMELA YOUNG (LPCC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:YOUNG
Last Name:JONES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1496 ORNDORFF MILL ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-8883
Mailing Address - Country:US
Mailing Address - Phone:270-725-4022
Mailing Address - Fax:270-725-4022
Practice Address - Street 1:151 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1401
Practice Address - Country:US
Practice Address - Phone:270-725-4022
Practice Address - Fax:270-731-0001
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional