1255622569 NPI number — MRS. PAMELA DAWN CUBAS MA, MFT; LPC-US

Table of content: MRS. PAMELA DAWN CUBAS MA, MFT; LPC-US (NPI 1255622569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255622569 NPI number — MRS. PAMELA DAWN CUBAS MA, MFT; LPC-US

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUBAS
Provider First Name:
PAMELA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, MFT; LPC-US
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255622569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5355 CHIDLAW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINKER AFB
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73145-4523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-803-9189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6803 S WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73139-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-634-4434
Provider Business Practice Location Address Fax Number:
405-664-8443
Provider Enumeration Date:
04/21/2011

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com