Provider Demographics
NPI:1023224896
Name:WEBSTER, PAMELA W (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:W
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71642
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1642
Mailing Address - Country:US
Mailing Address - Phone:907-479-7242
Mailing Address - Fax:907-479-6088
Practice Address - Street 1:250 CUSHMAN ST
Practice Address - Street 2:SUITE 4F
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4640
Practice Address - Country:US
Practice Address - Phone:907-479-7242
Practice Address - Fax:907-479-6088
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLCS 103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK92-0150680OtherEIN