Provider Demographics
NPI:1467508721
Name:MIKEWORTH, PAMELA M (MS COUNSELOR EDUCA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:M
Last Name:MIKEWORTH
Suffix:
Gender:F
Credentials:MS COUNSELOR EDUCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4925 SW JAMIESON RD APT 52
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3577
Mailing Address - Country:US
Mailing Address - Phone:503-363-2021
Mailing Address - Fax:503-363-4820
Practice Address - Street 1:4925 SW JAMIESON RD APT 52
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3577
Practice Address - Country:US
Practice Address - Phone:503-363-2021
Practice Address - Fax:503-363-4820
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)