Provider Demographics
NPI:1134181902
Name:TRICE, PAMELA DIANE (PSYD, LCPC, LMT)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DIANE
Last Name:TRICE
Suffix:
Gender:F
Credentials:PSYD, LCPC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5878 MIZPAH CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1841
Mailing Address - Country:US
Mailing Address - Phone:630-207-5537
Mailing Address - Fax:630-221-1606
Practice Address - Street 1:5878 MIZPAH CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-1841
Practice Address - Country:US
Practice Address - Phone:630-207-5537
Practice Address - Fax:888-873-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227014528225700000X
FLMH22844101YM0800X
IL180005746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional