MEDICARE: PAMELA POULTER

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	101YM0800X	Mental Health Counselor	95920	TX

General Provider Information

NPI Number	:	1235093337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA POULTER

Provider Business Mailing Address
First Line	:	9901 BRODIE LN STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5892
Country	:	US
Telephone Number	:	254-505-3407
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 BRODIE LN STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5892
Country	:	US
Telephone Number	:	254-505-3407
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	05/06/2026

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Directions to “ PAMELA POULTER ” Practice Location

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