Healthcare Provider Details

I. General information

NPI: 1427015437
Provider Name (Legal Business Name): PAMELA J TANNEHILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N 2ND ST
ROGERS AR
72756-6647
US

IV. Provider business mailing address

324 N 2ND ST
ROGERS AR
72756-6647
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-0566
  • Fax: 479-986-0599
Mailing address:
  • Phone: 479-986-0566
  • Fax: 479-986-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1978-C
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: