1740732270 NPI number — PAMELA JEAN SEVERSON LMHC

Table of content: PAMELA JEAN SEVERSON LMHC (NPI 1740732270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740732270 NPI number — PAMELA JEAN SEVERSON LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEVERSON
Provider First Name:
PAMELA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOE
Provider Other First Name:
PAMELA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740732270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 BOYSON RD STE D2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52233-2211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-440-7317
Provider Business Mailing Address Fax Number:
319-423-6123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 BOYSON RD STE D2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIAWATHA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-596-6800
Provider Business Practice Location Address Fax Number:
319-423-6123
Provider Enumeration Date:
11/01/2016

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: 101YM0800X , with the licence number:  078850 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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