Provider Demographics
NPI:1265153084
Name:MASH, PAMELA DIANE (COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DIANE
Last Name:MASH
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:DIANE
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 WORLEY WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-3608
Mailing Address - Country:US
Mailing Address - Phone:850-295-1909
Mailing Address - Fax:
Practice Address - Street 1:20274 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1957
Practice Address - Country:US
Practice Address - Phone:850-674-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health