=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841357258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA S. MUNSON M.A. L.C.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 197 W HARRISON ST SUITE 1
-----------------------------------------------------
City | BOURBONNAIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60914-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-802-0479
-----------------------------------------------------
Fax | 815-802-0479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3145 EAST 2780 NORTH ROAD
-----------------------------------------------------
City | DONOVAN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60931-8018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-486-7482
-----------------------------------------------------
Fax | 815-486-7482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------