Provider Demographics
NPI:1154339638
Name:HAYNES, PAMELA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:KINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14138 HWY 195
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4850
Mailing Address - Country:US
Mailing Address - Phone:254-519-1144
Mailing Address - Fax:254-519-1155
Practice Address - Street 1:12416 HYMEADOW DR STE 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2284
Practice Address - Country:US
Practice Address - Phone:254-519-1144
Practice Address - Fax:254-519-1155
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS39473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174427801Medicaid