Provider Demographics
NPI:1104043256
Name:WAMPLER, PAMELA D (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:D
Last Name:WAMPLER
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 1:815 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1712
Mailing Address - Country:US
Mailing Address - Phone:317-255-8973
Mailing Address - Fax:317-202-0750
Practice Address - Street 1:815 MAIN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1712
Practice Address - Country:US
Practice Address - Phone:317-255-8973
Practice Address - Fax:317-202-0750
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001469A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000225471OtherANTHEM PROVIDER ID