Healthcare Provider Details

I. General information

NPI: 1497811038
Provider Name (Legal Business Name): PAMELA K BEVERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E WATT ST
ALCOA TN
37701-2236
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-273-1616
  • Fax: 865-273-1645
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004464
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: