Provider Demographics
NPI:1972035723
Name:IRWIN, PAMELA (BCBA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 FORTVIEW RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7657
Mailing Address - Country:US
Mailing Address - Phone:512-351-7837
Mailing Address - Fax:
Practice Address - Street 1:1250 S A W GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7429
Practice Address - Country:US
Practice Address - Phone:512-351-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst