Provider Demographics
NPI:1093932865
Name:STELK, PAMELA KATHRYN (LCDC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KATHRYN
Last Name:STELK
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 N 15TH A ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-2138
Mailing Address - Country:US
Mailing Address - Phone:254-640-0204
Mailing Address - Fax:
Practice Address - Street 1:2505 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7446
Practice Address - Country:US
Practice Address - Phone:254-753-3653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)