Provider Demographics
NPI:1861600710
Name:SMITH, PAMELA S (MS)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:SUSAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:8432 S SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2533
Mailing Address - Country:US
Mailing Address - Phone:303-377-2030
Mailing Address - Fax:
Practice Address - Street 1:848 1ST AVE N
Practice Address - Street 2:350
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6013
Practice Address - Country:US
Practice Address - Phone:239-398-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO823106H00000X
FL2287106H00000X
FLSEX THERAPIST174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist