Doctor Name: | DR. PAMELA JO HARTMAN |
NPI Number: | 1154528529 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.MIN., LPC |
License Number: | 0090511 |
Business Practice Address: | 903c 5th St. Estancia, NM - 870160807 |
Business Phone Number: | 5053842777 |
Business Fax Number: | 5053842204 |
Mailing Address: | P.o. Box 132, CORONA |
State: | NM |
Postal Code: | 883180132 |
Phone Number: | 5058492924 |
Fax Number: | |
NPI Enumeration Date: | 06/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0090511 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |