Provider Demographics
NPI:1902226962
Name:TOPP, PAMALA (LPC)
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:TOPP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KEMP PL E APT 212
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-8509
Mailing Address - Country:US
Mailing Address - Phone:269-364-9462
Mailing Address - Fax:
Practice Address - Street 1:2000 KEMP PL E APT 212
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-8509
Practice Address - Country:US
Practice Address - Phone:269-364-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20726101YP2500X
MI6401019479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902226962Medicaid