Healthcare Provider Details

I. General information

NPI: 1417378571
Provider Name (Legal Business Name): LAURA BOWMAN PAMER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 A1A S STE B
ST AUGUSTINE FL
32080-2916
US

IV. Provider business mailing address

281 N CHURCHILL DR
SAINT AUGUSTINE FL
32086-4169
US

V. Phone/Fax

Practice location:
  • Phone: 727-641-1410
  • Fax:
Mailing address:
  • Phone: 727-641-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 11909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: