Healthcare Provider Details

I. General information

NPI: 1528496189
Provider Name (Legal Business Name): PAMELA DUVALLRICHARDSON LAY COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 DURANGO CREEK DR
MAGNOLIA TX
77354-2782
US

IV. Provider business mailing address

7115 DURANGO CREEK DR
MAGNOLIA TX
77354-2782
US

V. Phone/Fax

Practice location:
  • Phone: 231-343-2753
  • Fax:
Mailing address:
  • Phone: 231-343-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: