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NPI Code Detail

MEDICARE: PAMELA K FULBROOK M.A. LMFT

MEDICARE: PAMELA K FULBROOK M.A. LMFT
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1447408604
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA K FULBROOK M.A. LMFT
Provider Business Mailing Address
First Line : 5420 W SAHARA AVE STE 201
Second Line : S
City : LAS VEGAS
State : NV
Zip : 89146-0389
Country : US
Telephone Number : 702-686-2069
Fax Number : 702-686-2069
Provider Business Practice Location Address
First Line : 5420 W SAHARA AVE STE 201
Second Line : S
City : LAS VEGAS
State : NV
Zip : 89146-0389
Country : US
Telephone Number : 702-686-2069
Fax Number : 702-686-2069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2008
Last Update Date : 04/24/2014

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