Healthcare Provider Details

I. General information

NPI: 1366801847
Provider Name (Legal Business Name): PAMELA SCHUTTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W TOWN PL SUITE 205 D
ST AUGUSTINE FL
32092-3648
US

IV. Provider business mailing address

475 W TOWN PL SUITE 205 D
ST AUGUSTINE FL
32092-3648
US

V. Phone/Fax

Practice location:
  • Phone: 904-484-2158
  • Fax:
Mailing address:
  • Phone: 904-484-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SCHUTTER
Title or Position: OWNER
Credential: LMFT
Phone: 940-484-2158