Provider Demographics
NPI:1821285230
Name:PAM CLINE MSW-LCSW SUPPORTIVE COUNSELING CENTER
Entity Type:Organization
Organization Name:PAM CLINE MSW-LCSW SUPPORTIVE COUNSELING CENTER
Other - Org Name:PAM CLINE LCSW SUPPORTIVE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:541-728-8297
Mailing Address - Street 1:28 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1827
Mailing Address - Country:US
Mailing Address - Phone:541-475-6171
Mailing Address - Fax:541-475-6171
Practice Address - Street 1:28 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1827
Practice Address - Country:US
Practice Address - Phone:541-475-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES SOLE PROPRITERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3005251K00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251K00000XAgenciesPublic Health or Welfare