1013074905 NPI number — MS. PAMELA JEAN SPENCER NCC, LPC

Table of content: (NPI 1740643774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013074905 NPI number — MS. PAMELA JEAN SPENCER NCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
PAMELA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NCC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SENKO
Provider Other First Name:
PAMELA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NCC, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013074905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 11TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80501-4323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-231-0439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 CRESTRIDGE ST
Provider Second Line Business Practice Location Address:
SUMMITSTONE HEALTH PARTNERS
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-494-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4590 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)