Provider Demographics
NPI:1184039133
Name:HENDRICKS, PAMELA (LMFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HENDRICKS
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 1:2888 BROWNSBORO RD APT I3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1238
Mailing Address - Country:US
Mailing Address - Phone:804-938-0097
Mailing Address - Fax:
Practice Address - Street 1:2518 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2530
Practice Address - Country:US
Practice Address - Phone:804-938-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist