Provider Demographics
NPI:1316253420
Name:GILLON, PAMELA (LPC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:GILLON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:FAITH
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1600 WESTGATE CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8059
Mailing Address - Country:US
Mailing Address - Phone:615-463-6600
Mailing Address - Fax:
Practice Address - Street 1:1600 WESTGATE CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8059
Practice Address - Country:US
Practice Address - Phone:615-463-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health