Healthcare Provider Details

I. General information

NPI: 1184767600
Provider Name (Legal Business Name): PAMELA ROSE VANDERDOES M.DIV, MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/03/2020
Certification Date: 05/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31507 106TH PL SE APT S107
AUBURN WA
98092-3089
US

IV. Provider business mailing address

31507 106TH PL SE APT S107
AUBURN WA
98092-3089
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-6121
  • Fax: 888-884-6423
Mailing address:
  • Phone: 208-755-6121
  • Fax: 888-884-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60853457
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-3236
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: