Provider Demographics
NPI:1013207810
Name:PASTORE, GERALD MICHAEL (EDM LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MICHAEL
Last Name:PASTORE
Suffix:
Gender:M
Credentials:EDM LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 NW ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3607
Mailing Address - Country:US
Mailing Address - Phone:509-432-5254
Mailing Address - Fax:
Practice Address - Street 1:2240 WINROW AVE FORT HUACHUCA, AZ
Practice Address - Street 2:USA MEDDAC, RWBAHC
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003331101YA0400X
WALH 60163754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health