Healthcare Provider Details

I. General information

NPI: 1366539819
Provider Name (Legal Business Name): PAMELA JANE GRASSBAUGH LPCC., LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E. 32ND ST.
SILVER CITY NM
88061
US

IV. Provider business mailing address

1320 S. SOLANO
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-2693
  • Fax: 575-534-0120
Mailing address:
  • Phone: 575-527-7900
  • Fax: 575-571-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0117671
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0145801
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: