MEDICARE: PAMELA PARTRICK, LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	897	CO

General Provider Information

NPI Number	:	1144628850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA PARTRICK, LCSW, LLC

Provider Business Mailing Address
First Line	:	11311 RILL PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-4193
Country	:	US
Telephone Number	:	719-660-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 TEMPLETON GAP RD STE 205
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8714
Country	:	US
Telephone Number	:	719-660-9021
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA PARTRICK
Credential	:	LCSW
Telephone Number	:	719-660-9021

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	10/03/2019

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