Provider Demographics
NPI:1063422855
Name:PANNELL, ERIN LEE (MED, LPC, RPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:PANNELL
Suffix:
Gender:F
Credentials:MED, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 FM 1626
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3553
Mailing Address - Country:US
Mailing Address - Phone:512-280-4425
Mailing Address - Fax:512-280-4656
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:SUITE 103
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-280-4425
Practice Address - Fax:512-280-4656
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17905101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health