Provider Demographics
NPI:1083941298
Name:MARSHALL, PAMELA S (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-4239
Mailing Address - Country:US
Mailing Address - Phone:417-861-6419
Mailing Address - Fax:417-862-6764
Practice Address - Street 1:1531 E SUNSHINE ST
Practice Address - Street 2:STE W-29
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1213
Practice Address - Country:US
Practice Address - Phone:417-861-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005030087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional