Provider Demographics
NPI:1194816033
Name:PARTRICK, PAMELA G (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:PARTRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 RILL PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4193
Mailing Address - Country:US
Mailing Address - Phone:719-660-9021
Mailing Address - Fax:719-266-3085
Practice Address - Street 1:3225 TEMPLETON GAP RD STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8714
Practice Address - Country:US
Practice Address - Phone:719-660-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical