Provider Demographics
NPI:1417011578
Name:COLOMBIK, PAMELA J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:COLOMBIK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CLARKE STREET SUITE 6
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301
Mailing Address - Country:US
Mailing Address - Phone:406-234-7890
Mailing Address - Fax:406-234-7898
Practice Address - Street 1:2000 CLARKE ST, SUITE # 6
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301
Practice Address - Country:US
Practice Address - Phone:406-234-7890
Practice Address - Fax:406-234-7890
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT750101YM0800X
MTLCPC-750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000255527Medicaid