Provider Demographics
NPI:1225243470
Name:PAMELA GATES MA LPC, LCDC, INC
Entity Type:Organization
Organization Name:PAMELA GATES MA LPC, LCDC, INC
Other - Org Name:PAMELA GATES MA. LPC, LCDC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GATES
Authorized Official - Suffix:I
Authorized Official - Credentials:LPC-S,LCDC, ADCIII
Authorized Official - Phone:512-328-2563
Mailing Address - Street 1:616 PETERSON LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4108
Mailing Address - Country:US
Mailing Address - Phone:512-328-2563
Mailing Address - Fax:
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BLDG. B, SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7762
Practice Address - Country:US
Practice Address - Phone:512-328-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6991101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019EXOtherBLUE CROSS BLE SHILED
TX2163917Medicaid