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General NPI Number Information
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NPI Number | 1417378571
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Entity Type | Individual
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Provider Name | LAURA BOWMAN PAMER LMHC
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Gender | Female
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 2225 A1A S STE B
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-2916
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Country | US
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Telephone | 727-641-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 281 N CHURCHILL DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-4169
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Country | US
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Telephone | 727-641-1410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 11909
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License Number State | FL
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