Provider Demographics
NPI:1669851788
Name:MCSPADDEN, PAMELA GAIL
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GAIL
Last Name:MCSPADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:SMITH
Other - Last Name:MCSPADDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1914 PARADISE ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-8111
Mailing Address - Country:US
Mailing Address - Phone:940-839-7352
Mailing Address - Fax:
Practice Address - Street 1:1914 PARADISE ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-8111
Practice Address - Country:US
Practice Address - Phone:940-553-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71125101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional