Provider Demographics
NPI:1184767600
Name:VANDERDOES, PAMELA ROSE (MDIV, MS, LMHC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ROSE
Last Name:VANDERDOES
Suffix:
Gender:F
Credentials:MDIV, MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31507 106TH PL SE APT S107
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3089
Mailing Address - Country:US
Mailing Address - Phone:208-755-6121
Mailing Address - Fax:888-884-6423
Practice Address - Street 1:31507 106TH PL SE APT S107
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-3089
Practice Address - Country:US
Practice Address - Phone:208-755-6121
Practice Address - Fax:888-884-6423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X, 106H00000X
WA60853457101YM0800X
IDLPC-3236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist