Provider Demographics
NPI:1578236881
Name:NORRIS, PAMELA D (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 WILTON TER
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-6939
Mailing Address - Country:US
Mailing Address - Phone:469-955-3210
Mailing Address - Fax:
Practice Address - Street 1:142 OLD TOWN BLVD N STE 200
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-3954
Practice Address - Country:US
Practice Address - Phone:904-294-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional