Healthcare Provider Details

I. General information

NPI: 1578688420
Provider Name (Legal Business Name): PAMELA MAE MORGRIDGE MA, LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 W MAIN ST. SUITE C-3
GAYLORD MI
49735
US

IV. Provider business mailing address

829 W MAIN ST. SUITE C-3
GAYLORD MI
49735
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-6761
  • Fax: 989-732-6763
Mailing address:
  • Phone: 989-732-6761
  • Fax: 989-732-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: