Provider Demographics
NPI:1770596520
Name:GATES, PAMELA HART (MA, LPC, LCDC, ADC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:HART
Last Name:GATES
Suffix:
Gender:F
Credentials:MA, LPC, LCDC, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PETERSON LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4108
Mailing Address - Country:US
Mailing Address - Phone:512-328-2563
Mailing Address - Fax:
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY STE B201
Practice Address - Street 2:BUILDING B STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7758
Practice Address - Country:US
Practice Address - Phone:512-328-2563
Practice Address - Fax:512-328-3034
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2163917Medicaid
TX742965114OtherEIN