Provider Demographics
NPI:1407978927
Name:LANDERS, PAMELA PHILLIPS (MS)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:PHILLIPS
Last Name:LANDERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 MCKINZIE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2630
Mailing Address - Country:US
Mailing Address - Phone:361-241-3600
Mailing Address - Fax:361-241-3600
Practice Address - Street 1:3153 MCKINZIE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-2630
Practice Address - Country:US
Practice Address - Phone:361-241-3600
Practice Address - Fax:361-241-3600
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1527491-01Medicaid