Provider Demographics
NPI:1144871070
Name:CANCEL, PAMELA (LPC-I)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CANCEL
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BENSON WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9564
Mailing Address - Country:US
Mailing Address - Phone:541-625-0989
Mailing Address - Fax:
Practice Address - Street 1:1000 BENSON WAY STE 204
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9564
Practice Address - Country:US
Practice Address - Phone:541-625-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional