Provider Demographics
NPI:1578923447
Name:PAMELA LASTER, NTS, LMT, ADS
Entity Type:Organization
Organization Name:PAMELA LASTER, NTS, LMT, ADS
Other - Org Name:WINDSONG NATURAL THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, ADS
Authorized Official - Phone:318-243-2231
Mailing Address - Street 1:1738 W KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-9581
Mailing Address - Country:US
Mailing Address - Phone:318-243-2231
Mailing Address - Fax:
Practice Address - Street 1:1738 W KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-9581
Practice Address - Country:US
Practice Address - Phone:318-243-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA000024171100000X
LA0309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty