Provider Demographics
NPI:1619486545
Name:HAFEMANN, PAMELA DIANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DIANE
Last Name:HAFEMANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 CONDOR DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5985
Mailing Address - Country:US
Mailing Address - Phone:214-673-8546
Mailing Address - Fax:214-673-8546
Practice Address - Street 1:4209 GATEWAY DR STE 235
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7912
Practice Address - Country:US
Practice Address - Phone:214-672-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional