Provider Demographics
NPI:1548534225
Name:WACHTEL, PAMELA (LMFT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5489 WILES RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4220
Mailing Address - Country:US
Mailing Address - Phone:954-288-9393
Mailing Address - Fax:954-333-3573
Practice Address - Street 1:5489 WILES RD
Practice Address - Street 2:SUITE 305
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4220
Practice Address - Country:US
Practice Address - Phone:954-288-9393
Practice Address - Fax:954-333-3573
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist