Healthcare Provider Details

I. General information

NPI: 1619312519
Provider Name (Legal Business Name): PAMELA GAY ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TROY SQ
TROY MO
63379-3108
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax: 314-918-1521
Mailing address:
  • Phone:
  • Fax: 314-918-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2019023151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: