Provider Demographics
NPI:1790847127
Name:FLETCHER, PAMELA KRAKE (MS,LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KRAKE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MS,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUITE 107-358
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3699
Mailing Address - Country:US
Mailing Address - Phone:321-749-3589
Mailing Address - Fax:
Practice Address - Street 1:1000 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4702
Practice Address - Country:US
Practice Address - Phone:321-749-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health