Provider Demographics
NPI:1962648899
Name:PAMP, JERI LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:LOUISE
Last Name:PAMP
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 1:201 THANKHOHAY POE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-8343
Mailing Address - Country:US
Mailing Address - Phone:512-745-6376
Mailing Address - Fax:
Practice Address - Street 1:201 THANKHOHAY POE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-8343
Practice Address - Country:US
Practice Address - Phone:512-745-6376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81185106H00000X
TX17694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist