Healthcare Provider Details

I. General information

NPI: 1730242256
Provider Name (Legal Business Name): PAMELA ANN MARSHALL LBSW LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ST MICHAELS DR STE 8A
SANTA FE NM
87505
US

IV. Provider business mailing address

411 ST MICHAELS DR STE 8A
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-3333
  • Fax: 505-984-3003
Mailing address:
  • Phone: 505-989-3333
  • Fax: 505-984-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC1844
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLBSWB3277
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: