Provider Demographics
NPI:1699885921
Name:MATTHEWS, PAMELA J (PHD, LPC, LCSW)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHD, LPC, LCSW
Other - Prefix:DR
Other - First Name:PAM
Other - Middle Name:J
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC, LCSW
Mailing Address - Street 1:4459 W FLAGSTICK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7527
Mailing Address - Country:US
Mailing Address - Phone:479-587-1742
Mailing Address - Fax:
Practice Address - Street 1:525 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3110
Practice Address - Country:US
Practice Address - Phone:479-575-5276
Practice Address - Fax:479-575-7438
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0502010101YP2500X
AR729-C1041C0700X
AR17944146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic