Provider Demographics
NPI:1174977466
Name:CRUDUP-ARATA, PAMELA T (MS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:T
Last Name:CRUDUP-ARATA
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 1:6073 ARMISTEAD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002
Mailing Address - Country:US
Mailing Address - Phone:901-233-2422
Mailing Address - Fax:
Practice Address - Street 1:8570 CORDES CIR STE 9
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3341
Practice Address - Country:US
Practice Address - Phone:901-466-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health