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General NPI Number Information
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NPI Number | 1487994018
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Entity Type | Individual
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Provider Name | PAMELA CHRISTINE BUXTON LPC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 2635 CHANNING WAY SUITE B
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7518
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Country | US
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Telephone | 208-552-0490
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Fax | 208-552-2518
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Provider Business Mailing Address
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Address Line | PO BOX 2651
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2651
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-5192
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License Number State | ID
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