Provider Demographics
NPI:1578700696
Name:LONDON, PAMELA RENEE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:LONDON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:RENEE
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:KREBS
Mailing Address - State:OK
Mailing Address - Zip Code:74554-0473
Mailing Address - Country:US
Mailing Address - Phone:918-429-3156
Mailing Address - Fax:918-423-2741
Practice Address - Street 1:785 W. WASHINGTON
Practice Address - Street 2:
Practice Address - City:KREBS
Practice Address - State:OK
Practice Address - Zip Code:74554
Practice Address - Country:US
Practice Address - Phone:918-429-3156
Practice Address - Fax:918-423-2741
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health