Healthcare Provider Details

I. General information

NPI: 1154528529
Provider Name (Legal Business Name): PAMELA JO HARTMAN D.MIN., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903C 5TH ST.
ESTANCIA NM
87016-0807
US

IV. Provider business mailing address

P.O. BOX 132
CORONA NM
88318-0132
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-2777
  • Fax: 505-384-2204
Mailing address:
  • Phone: 505-849-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0090511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: