Provider Demographics
NPI:1922436260
Name:THOMPSON, PAMELA (BA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ELIZABETH
Other - Last Name:KRACHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1404
Mailing Address - Country:US
Mailing Address - Phone:918-421-3500
Mailing Address - Fax:918-423-2370
Practice Address - Street 1:107 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3052
Practice Address - Country:US
Practice Address - Phone:918-689-3265
Practice Address - Fax:918-689-3359
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)