Provider Demographics
NPI:1790955771
Name:FLORES, PAMELA JEAN (LMHC, LSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:FLORES
Suffix:
Gender:F
Credentials:LMHC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 N SHADELAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1762
Mailing Address - Country:US
Mailing Address - Phone:317-635-3499
Mailing Address - Fax:317-635-0449
Practice Address - Street 1:2060 N SHADELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1762
Practice Address - Country:US
Practice Address - Phone:317-635-3499
Practice Address - Fax:317-635-0449
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33001931A104100000X
IN39002223A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530Medicaid
IN150074Medicare PIN