Provider Demographics
NPI:1619034972
Name:PEDROW, PAMELA R (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:PEDROW
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GAY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1307
Mailing Address - Country:US
Mailing Address - Phone:303-651-7044
Mailing Address - Fax:303-776-0253
Practice Address - Street 1:2101 GAY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1307
Practice Address - Country:US
Practice Address - Phone:303-651-7044
Practice Address - Fax:303-776-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1721OtherSTATE COUNSELOR LISCENCE