Provider Demographics
NPI:1619991825
Name:MONG, PAMELA T (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:T
Last Name:MONG
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 1:9456 JEFFERSON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2883
Mailing Address - Country:US
Mailing Address - Phone:225-293-2255
Mailing Address - Fax:225-292-1900
Practice Address - Street 1:9456 JEFFERSON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2883
Practice Address - Country:US
Practice Address - Phone:225-293-2255
Practice Address - Fax:225-292-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF5230OtherBLUE CROSS PROVIDER #
LA5S307Medicare PIN