Provider Demographics
NPI:1538331038
Name:BASHAM, PAMELA M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:BASHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:MOYLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4633 SMOKEY RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9270
Mailing Address - Country:US
Mailing Address - Phone:850-934-4151
Mailing Address - Fax:
Practice Address - Street 1:1150 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3308
Practice Address - Country:US
Practice Address - Phone:850-384-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health