Basic Information
| Provider Information | |||||||||
| NPI: | 1295079481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIGGS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | OLETTA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7 | ||||||||
| Address2: | |||||||||
| City: | CLARKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427260007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702346139 | ||||||||
| FaxNumber: | 8558591695 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 MILLERSTOWN ST | ||||||||
| Address2: | |||||||||
| City: | CLARKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702346139 | ||||||||
| FaxNumber: | 8558591695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2012 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | KY-1490 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7100276780 | 05 | KY | MEDICAID |