MEDICARE: PAMELA TAYLOR LCSW

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	1041C0700X	Clinical Social Worker	5872-C	AR
2	101YM0800X	Mental Health Counselor

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	:	1639306186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA TAYLOR LCSW

Provider Business Mailing Address
First Line	:	4303 PITMAN ST
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4473
Country	:	US
Telephone Number	:	405-403-8513
Fax Number	:	405-456-7572

Provider Business Practice Location Address
First Line	:	4303 PITMAN ST
Second Line	:
City	:	FORT SILL
State	:	OK
Zip	:	73503-4473
Country	:	US
Telephone Number	:	405-403-8513
Fax Number	:	405-456-7572

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

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	11/22/2024

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