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General NPI Number Information
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NPI Number | 1396236246
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Entity Type | Organization
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Legal Business Name | PAMELA ANDERSON LCSW LLC
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Dates
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Enumeration Date | 05/27/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 2501 BLICHMAN AVE STE 117
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-1031
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Country | US
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Telephone | 970-644-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 383 ROSEMARY WAY
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-4452
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Country | US
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Telephone | 970-644-2950
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Fax |
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Authorized Official
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Title or Position | BILLING AGENT
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Name | MELENIE SNYDER
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Credential |
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Telephone | 970-628-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00000661
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License Number State | CO
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