Provider Demographics
NPI:1578688420
Name:MORGRIDGE, PAMELA MAE (MA, LPC, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MAE
Last Name:MORGRIDGE
Suffix:
Gender:F
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W MAIN ST.
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:989-732-6761
Mailing Address - Fax:989-732-6763
Practice Address - Street 1:829 W MAIN ST.
Practice Address - Street 2:SUITE C-3
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-6761
Practice Address - Fax:989-732-6763
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401009228OtherLICENSE