1265416820 NPI number — PAMELA ELIN KURTHY LICSW ACSW

Table of content: PAMELA ELIN KURTHY LICSW ACSW (NPI 1265416820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265416820 NPI number — PAMELA ELIN KURTHY LICSW ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTHY
Provider First Name:
PAMELA
Provider Middle Name:
ELIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW ACSW
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:
1265416820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1808 ALMA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KELSO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98626-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-577-6559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1339 COMMERCE AVE
Provider Second Line Business Practice Location Address:
STE 310D
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-3738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-577-6559
Provider Business Practice Location Address Fax Number:
360-425-1940
Provider Enumeration Date:
12/06/2005

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: 103T00000X , with the licence number:  LW00005251 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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