MEDICARE: MS. PAMELA NICOLE GREEN LMHCA

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	101YM0800X	Mental Health Counselor	MC61325934	WA

General Provider Information

NPI Number	:	1639803703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA NICOLE GREEN LMHCA

Provider Business Mailing Address
First Line	:	3418 NE 65TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 NE 65TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7341
Country	:	US
Telephone Number	:	702-427-1446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	08/23/2023

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