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General NPI Number Information
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NPI Number | 1619486545
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Entity Type | Individual
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Provider Name | PAMELA DIANE HAFEMANN LPC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 4209 GATEWAY DR STE 235
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City | COLLEYVILLE
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State | TX
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Zip | 76034-7912
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Country | US
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Telephone | 214-672-8546
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Fax |
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Provider Business Mailing Address
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Address Line | 964 CONDOR DR
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City | COPPELL
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State | TX
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Zip | 75019-5985
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Country | US
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Telephone | 214-673-8546
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Fax | 214-673-8546
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73446
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License Number State | TX
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