Basic Information
Provider Information
NPI: 1033559315
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MASSEY
FirstName: PAMELA
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 301 UNIVERSITY BLVD
Address2:  
City: GALVESTON
State: TX
PostalCode: 775555302
CountryCode: US
TelephoneNumber: 4097722222
FaxNumber:  
Practice Location
Address1: 304 TANGLEWOOD DR
Address2:  
City: DICKINSON
State: TX
PostalCode: 775394333
CountryCode: US
TelephoneNumber: 2815346755
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/01/2013
LastUpdateDate: 07/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X21388TXY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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