Provider Demographics
NPI:1164587143
Name:ELDERKIN, PAMELA SYLVIA (MA LMHC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SYLVIA
Last Name:ELDERKIN
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-0826
Mailing Address - Country:US
Mailing Address - Phone:253-884-3385
Mailing Address - Fax:253-884-3385
Practice Address - Street 1:4109 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE B
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4328
Practice Address - Country:US
Practice Address - Phone:253-884-3385
Practice Address - Fax:253-884-3385
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003586101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor