Provider Demographics
NPI:1801001284
Name:ROBISON, PAMELA SUE (LSAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:ROBISON
Suffix:
Gender:F
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E 100 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2115
Mailing Address - Country:US
Mailing Address - Phone:435-789-6300
Mailing Address - Fax:435-789-6325
Practice Address - Street 1:1140 W 500 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2914
Practice Address - Country:US
Practice Address - Phone:435-789-6300
Practice Address - Fax:435-789-6325
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3182406006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)