MEDICARE: PAMELA K WITHROW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	164299	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528577194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA K WITHROW

Provider Business Mailing Address
First Line	:	8401 CLAUDE THOMAS RD STE 38
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1475
Country	:	US
Telephone Number	:	937-723-0883
Fax Number	:	937-514-7014

Provider Business Practice Location Address
First Line	:	8401 CLAUDE THOMAS RD STE 38
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1475
Country	:	US
Telephone Number	:	937-723-0883
Fax Number	:	937-514-7014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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Directions to “ PAMELA K WITHROW ” Practice Location

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