Provider Demographics
NPI:1205309606
Name:PANNEL, TAMIKA ALISHA
Entity type:Individual
Prefix:MISS
First Name:TAMIKA
Middle Name:ALISHA
Last Name:PANNEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N ARLINGTON AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3260
Mailing Address - Country:US
Mailing Address - Phone:317-734-3897
Mailing Address - Fax:
Practice Address - Street 1:1311 N ARLINGTON AVE STE 209
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3260
Practice Address - Country:US
Practice Address - Phone:317-734-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health