Provider Demographics
NPI:1649843384
Name:MCCARTY, ILEAN PAMELA
Entity type:Individual
Prefix:
First Name:ILEAN
Middle Name:PAMELA
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILEAN
Other - Middle Name:PAMELA
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-1347
Mailing Address - Country:US
Mailing Address - Phone:806-410-0558
Mailing Address - Fax:
Practice Address - Street 1:2417 HOBBS RD STE 105
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1533
Practice Address - Country:US
Practice Address - Phone:806-410-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical