Doctor Name: | MRS. PAM GERDES |
NPI Number: | 1265887392 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 6130 |
Business Practice Address: | 695 2nd Ave S Payette, ID - 836612801 |
Business Phone Number: | 2082910005 |
Business Fax Number: | |
Mailing Address: | Po Box 504, PAYETTE |
State: | ID |
Postal Code: | 836610504 |
Phone Number: | 2082910005 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2016 |
NPI Last Update Date: | 04/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |