Provider Demographics
NPI:1518583079
Name:WAIBEL, PAMELA GRACE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:GRACE
Last Name:WAIBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:GRACE
Other - Last Name:PREWETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2527
Mailing Address - Country:US
Mailing Address - Phone:989-779-8999
Mailing Address - Fax:989-779-2219
Practice Address - Street 1:201 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2527
Practice Address - Country:US
Practice Address - Phone:989-779-8999
Practice Address - Fax:989-779-2219
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional