Provider Demographics
NPI:1518988427
Name:MANN, PAMELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:MANN
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 1:6260 N SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-9541
Mailing Address - Country:US
Mailing Address - Phone:406-458-3883
Mailing Address - Fax:
Practice Address - Street 1:6260 N SLOPE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-9541
Practice Address - Country:US
Practice Address - Phone:406-458-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT619 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000700623OtherBLUE CROSS-SHIELD OF MONTANA CENTER FOR MENTAL HEALTH
MT0000700623OtherBLUE CROSS-SHIELD OF MONTANA CENTER FOR MENTAL HEALTH