1598938417 NPI number — MS. PAMELA CAROLE GRISHAM MA LPC 11838

Table of content: MS. PAMELA CAROLE GRISHAM MA LPC 11838 (NPI 1598938417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598938417 NPI number — MS. PAMELA CAROLE GRISHAM MA LPC 11838

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRISHAM
Provider First Name:
PAMELA
Provider Middle Name:
CAROLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC 11838
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRISHAM
Provider Other First Name:
PAMELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA LPC LMFT NCC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598938417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2774
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-691-7898
Provider Business Mailing Address Fax Number:
817-267-7036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 SHADYBROOK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-691-7898
Provider Business Practice Location Address Fax Number:
817-267-7036
Provider Enumeration Date:
04/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  41171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 11838 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4005 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)