Provider Demographics
NPI:1417597022
Name:GIVENS, PAMELA COOLIE
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:COOLIE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 N 1-10 SERVICE RD W. METAIRIE
Mailing Address - Street 2:NEW ORLEANS,LOUISIANA, 70006
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:504-475-5303
Mailing Address - Fax:888-880-9270
Practice Address - Street 1:4747 EARHART BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1743
Practice Address - Country:US
Practice Address - Phone:504-482-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician