Provider Demographics
NPI:1871683136
Name:PERLITZ, PAMELA M (MS, LPC, LCDC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:M
Last Name:PERLITZ
Suffix:
Gender:F
Credentials:MS, LPC, LCDC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 TREEHOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5748
Mailing Address - Country:US
Mailing Address - Phone:979-691-8500
Mailing Address - Fax:979-691-5755
Practice Address - Street 1:4343 CARTER CREEK PKWY
Practice Address - Street 2:SUITE 119
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4491
Practice Address - Country:US
Practice Address - Phone:979-691-8500
Practice Address - Fax:979-691-5755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4194101YA0400X
TX11302101YP2500X
TX2765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist