Provider Demographics
NPI:1013074905
Name:SPENCER, PAMELA JEAN (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:SENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC, LPC
Mailing Address - Street 1:408 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4323
Mailing Address - Country:US
Mailing Address - Phone:970-231-0439
Mailing Address - Fax:
Practice Address - Street 1:125 CRESTRIDGE ST
Practice Address - Street 2:SUMMITSTONE HEALTH PARTNERS
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4590101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional