Provider Demographics
NPI:1326522483
Name:HYLES, PAMELA SUE (LMSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:HYLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4974
Mailing Address - Country:US
Mailing Address - Phone:248-390-9693
Mailing Address - Fax:
Practice Address - Street 1:6199 MILLER RD STE A
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1585
Practice Address - Country:US
Practice Address - Phone:248-390-9693
Practice Address - Fax:810-630-0962
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010831051041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801083105OtherSOCIAL WORK
MIH420676778881OtherDRIVERS LICENSE
MI14326290OtherCAQH