Healthcare Provider Details

I. General information

NPI: 1770614133
Provider Name (Legal Business Name): PAMELA JEAN ZITTERKOPF M.A. P.L.M.H.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 10TH ST
GERING NE
69341-2412
US

IV. Provider business mailing address

1720 10TH ST
GERING NE
69341-2412
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-3817
  • Fax: 304-436-4716
Mailing address:
  • Phone: 308-436-3817
  • Fax: 304-436-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8118
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: